Domain : Immunization
Version :
Contact :
Date : 2015-11-13 17:23:48
The administration group is design to test:
(1) the creation of a broad scope of immunization messages including support for new and historical administrations, refusals, combination vaccines, patient consent and various observations including VIS and VFC.
(2) the receipt and handling of various acknowledgement messages including application accept, application error, and application warning.
Test Cases consists of 2 steps:
(1) creating immunization messages based on the Immunization Messaging Standard (Z22 Profile) and specific Test Data, and
(2) receiving acknowledgment messages based on the Immunization Messaging Standard (Z23 Profile).
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | wcApp | Presence-Content Indifferent |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | issApp | Presence-Content Indifferent |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | IIS | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150624073733.994-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | VXU | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | VXU_V04 | Value-Profile Fixed |
| MSH-10 | Message Control ID | 12462 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | ER | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | AL | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z22 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | wcEHR | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | Indifferent | |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | Indifferent | |
| MSH-22.10 | Organization Identifier | Indifferent | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | IIS | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | Indifferent | |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | Indifferent | |
| MSH-23.10 | Organization Identifier | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID-1 | Set ID - PID | 1 | Value-Profile Fixed |
| PID-3 | Patient Identifier List | ||
| PID-3.1 | ID Number | 3123 | Presence-Content Indifferent |
| PID-3.3 | Check Digit Scheme | Indifferent | |
| PID-3.4 | Assigning Authority | ||
| PID-3.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| PID-3.4.2 | Universal ID | Indifferent | |
| PID-3.4.3 | Universal ID Type | Indifferent | |
| PID-3.5 | Identifier Type Code | MR | Presence-Content Indifferent |
| PID-5 | Patient Name | ||
| PID-5.1 | Family Name | ||
| PID-5.1.1 | Surname | Richardson | Presence-Content Indifferent |
| PID-5.1.2 | Own Surname Prefix | ||
| PID-5.1.3 | Own Surname | ||
| PID-5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-5.1.5 | Surname From Partner/Spouse | ||
| PID-5.2 | Given Name | Russell | Presence-Content Indifferent |
| PID-5.3 | Second and Further Given Names or Initials Thereof | Clint | Presence-Content Indifferent |
| PID-5.7 | Name Type Code | L | Presence-Content Indifferent |
| PID-6 | Mother's Maiden Name | ||
| PID-6.1 | Family Name | ||
| PID-6.1.1 | Surname | Billington | Presence-Content Indifferent |
| PID-6.1.2 | Own Surname Prefix | ||
| PID-6.1.3 | Own Surname | ||
| PID-6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-6.1.5 | Surname From Partner/Spouse | ||
| PID-6.7 | Name Type Code | M | Value-Profile Fixed |
| PID-7 | Date/Time of Birth | ||
| PID-7.1 | Time | 20150415 | Presence-Content Indifferent |
| PID-8 | Administrative Sex | M | Presence-Content Indifferent |
| PID-10 | Race | ||
| PID-10.1 | Identifier | 1002-5 | Presence-Content Indifferent |
| PID-10.2 | Text | American Indian or Alaska Native | Presence-Content Indifferent |
| PID-10.3 | Name of Coding System | CDCREC | Value-Profile Fixed |
| PID-10.5 | Alternate Text | Indifferent | |
| PID-10.6 | Name of Alternate Coding System | Indifferent | |
| PID-11 | Patient Address | ||
| PID-11.1 | Street Address | ||
| PID-11.1.1 | Street or Mailing Address | 543 Blount Drive | Presence-Content Indifferent |
| PID-11.1.2 | Street Name | ||
| PID-11.1.3 | Dwelling Number | ||
| PID-11.2 | Other Designation | Indifferent | |
| PID-11.3 | City | Bozeman | Presence-Content Indifferent |
| PID-11.4 | State or Province | MT | Presence-Content Indifferent |
| PID-11.5 | Zip or Postal Code | 59715 | Presence-Content Indifferent |
| PID-11.6 | Country | USA | Presence-Content Indifferent |
| PID-11.7 | Address Type | P | Presence-Content Indifferent |
| PID-13 | Phone Number - Home | ||
| PID-13.2 | Telecommunication Use Code | PRN | Presence-Content Indifferent |
| PID-13.3 | Telecommunication Equipment Type | PH | Value-Test Case Fixed |
| PID-13.4 | Email Address | NonPresence | |
| PID-13.6 | Area/City Code | 406 | Presence-Content Indifferent |
| PID-13.7 | Local Number | 5557690 | Presence-Content Indifferent |
| PID-22 | Ethnic Group | ||
| PID-22.1 | Identifier | 2186-5 | Presence-Content Indifferent |
| PID-22.2 | Text | Not Hispanic or Latino | Presence-Content Indifferent |
| PID-22.3 | Name of Coding System | CDCREC | Value-Profile Fixed |
| PID-22.5 | Alternate Text | Indifferent | |
| PID-22.6 | Name of Alternate Coding System | Indifferent | |
| PID-24 | Multiple Birth Indicator | N | Presence-Content Indifferent |
| PID-25 | Birth Order | 1 | Indifferent |
| PID-29 | Patient Death Date and Time | ||
| PID-29.1 | Time | Indifferent | |
| PID-30 | Patient Death Indicator | N | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1-11 | Publicity Code | ||
| PD1-11.1 | Identifier | 07 | Presence-Content Indifferent |
| PD1-11.2 | Text | Recall only - no calls | Presence-Content Indifferent |
| PD1-11.3 | Name of Coding System | HL70215 | Value-Profile Fixed |
| PD1-11.5 | Alternate Text | Indifferent | |
| PD1-11.6 | Name of Alternate Coding System | Indifferent | |
| PD1-12 | Protection Indicator | N | Value-Test Case Fixed |
| PD1-13 | Protection Indicator Effective Date | 20150624 | Presence-Content Indifferent |
| PD1-16 | Immunization Registry Status | A | Presence-Content Indifferent |
| PD1-17 | Immunization Registry Status Effective Date | 20150415 | Presence-Content Indifferent |
| PD1-18 | Publicity Code Effective Date | 20150624 | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| NK1-1 | Set ID - NK1 | 1 | Value-Profile Fixed |
| NK1-2 | Name | ||
| NK1-2.1 | Family Name | ||
| NK1-2.1.1 | Surname | Richardson | Presence-Content Indifferent |
| NK1-2.1.2 | Own Surname Prefix | ||
| NK1-2.1.3 | Own Surname | ||
| NK1-2.1.4 | Surname Prefix From Partner/Spouse | ||
| NK1-2.1.5 | Surname From Partner/Spouse | ||
| NK1-2.2 | Given Name | Maria | Presence-Content Indifferent |
| NK1-2.3 | Second and Further Given Names or Initials Thereof | Elizabeth | Presence-Content Indifferent |
| NK1-2.7 | Name Type Code | L | Presence-Content Indifferent |
| NK1-3 | Relationship | ||
| NK1-3.1 | Identifier | MTH | Presence-Content Indifferent |
| NK1-3.2 | Text | Mother | Presence-Content Indifferent |
| NK1-3.3 | Name of Coding System | HL70063 | Value-Profile Fixed |
| NK1-3.5 | Alternate Text | Indifferent | |
| NK1-3.6 | Name of Alternate Coding System | Indifferent | |
| NK1-4 | Address | ||
| NK1-4.1 | Street Address | ||
| NK1-4.1.1 | Street or Mailing Address | 543 Blount Drive | Presence-Content Indifferent |
| NK1-4.1.2 | Street Name | ||
| NK1-4.1.3 | Dwelling Number | ||
| NK1-4.2 | Other Designation | Indifferent | |
| NK1-4.3 | City | Bozeman | Presence-Content Indifferent |
| NK1-4.4 | State or Province | MT | Presence-Content Indifferent |
| NK1-4.5 | Zip or Postal Code | 59715 | Presence-Content Indifferent |
| NK1-4.6 | Country | USA | Presence-Content Indifferent |
| NK1-4.7 | Address Type | P | Presence-Content Indifferent |
| NK1-5 | Phone Number | ||
| NK1-5.2 | Telecommunication Use Code | PRN | Presence-Content Indifferent |
| NK1-5.3 | Telecommunication Equipment Type | PH | Value-Test Case Fixed |
| NK1-5.4 | Email Address | NonPresence | |
| NK1-5.6 | Area/City Code | 406 | Presence-Content Indifferent |
| NK1-5.7 | Local Number | 5557690 | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| NK1-1 | Set ID - NK1 | 2 | Value-Profile Fixed |
| NK1-2 | Name | ||
| NK1-2.1 | Family Name | ||
| NK1-2.1.1 | Surname | Richardson | Presence-Content Indifferent |
| NK1-2.1.2 | Own Surname Prefix | ||
| NK1-2.1.3 | Own Surname | ||
| NK1-2.1.4 | Surname Prefix From Partner/Spouse | ||
| NK1-2.1.5 | Surname From Partner/Spouse | ||
| NK1-2.2 | Given Name | John | Presence-Content Indifferent |
| NK1-2.3 | Second and Further Given Names or Initials Thereof | William | Presence-Content Indifferent |
| NK1-2.7 | Name Type Code | L | Presence-Content Indifferent |
| NK1-3 | Relationship | ||
| NK1-3.1 | Identifier | FTH | Presence-Content Indifferent |
| NK1-3.2 | Text | Father | Presence-Content Indifferent |
| NK1-3.3 | Name of Coding System | HL70063 | Value-Profile Fixed |
| NK1-3.5 | Alternate Text | Indifferent | |
| NK1-3.6 | Name of Alternate Coding System | Indifferent | |
| NK1-4 | Address | ||
| NK1-4.1 | Street Address | ||
| NK1-4.1.1 | Street or Mailing Address | 543 Blount Drive | Presence-Content Indifferent |
| NK1-4.1.2 | Street Name | ||
| NK1-4.1.3 | Dwelling Number | ||
| NK1-4.2 | Other Designation | Indifferent | |
| NK1-4.3 | City | Bozeman | Presence-Content Indifferent |
| NK1-4.4 | State or Province | MT | Presence-Content Indifferent |
| NK1-4.5 | Zip or Postal Code | 59715 | Presence-Content Indifferent |
| NK1-4.6 | Country | USA | Presence-Content Indifferent |
| NK1-4.7 | Address Type | P | Presence-Content Indifferent |
| NK1-5 | Phone Number | ||
| NK1-5.2 | Telecommunication Use Code | PRN | Presence-Content Indifferent |
| NK1-5.3 | Telecommunication Equipment Type | CP | Value-Test Case Fixed |
| NK1-5.4 | Email Address | NonPresence | |
| NK1-5.6 | Area/City Code | 406 | Presence-Content Indifferent |
| NK1-5.7 | Local Number | 5558299 | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | Value-Profile Fixed |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | 3140 | Presence-Content Indifferent |
| ORC-2.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-2.3 | Universal ID | Indifferent | |
| ORC-2.4 | Universal ID Type | Indifferent | |
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 38766 | Presence-Content Indifferent |
| ORC-3.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-3.3 | Universal ID | Indifferent | |
| ORC-3.4 | Universal ID Type | Indifferent | |
| ORC-10 | Entered By | ||
| ORC-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| ORC-10.2 | Family Name | ||
| ORC-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| ORC-10.2.2 | Own Surname Prefix | ||
| ORC-10.2.3 | Own Surname | ||
| ORC-10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-10.2.5 | Surname From Partner/Spouse | ||
| ORC-10.3 | Given Name | Lily | Presence-Content Indifferent |
| ORC-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| ORC-10.9 | Assigning Authority | ||
| ORC-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-10.9.2 | Universal ID | ||
| ORC-10.9.3 | Universal ID Type | ||
| ORC-10.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-10.12 | Check Digit Scheme | Indifferent | |
| ORC-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| ORC-12 | Ordering Provider | ||
| ORC-12.1 | ID Number | 654 | Presence-Content Indifferent |
| ORC-12.2 | Family Name | ||
| ORC-12.2.1 | Surname | Thomas | Presence-Content Indifferent |
| ORC-12.2.2 | Own Surname Prefix | ||
| ORC-12.2.3 | Own Surname | ||
| ORC-12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-12.2.5 | Surname From Partner/Spouse | ||
| ORC-12.3 | Given Name | Wilma | Presence-Content Indifferent |
| ORC-12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | Presence-Content Indifferent |
| ORC-12.9 | Assigning Authority | ||
| ORC-12.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-12.9.2 | Universal ID | ||
| ORC-12.9.3 | Universal ID Type | ||
| ORC-12.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-12.12 | Check Digit Scheme | Indifferent | |
| ORC-12.13 | Identifier Type Code | MD | Presence-Content Indifferent |
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | wcEHR | Presence-Content Indifferent |
| ORC-17.2 | Text | West Clinic | Presence-Content Indifferent |
| ORC-17.3 | Name of Coding System | HL70362 | Value-Profile Fixed |
| ORC-17.5 | Alternate Text | Indifferent | |
| ORC-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | Value-Profile Fixed |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | 8681 | Presence-Content Indifferent |
| ORC-2.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-2.3 | Universal ID | Indifferent | |
| ORC-2.4 | Universal ID Type | Indifferent | |
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 65138 | Presence-Content Indifferent |
| ORC-3.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-3.3 | Universal ID | Indifferent | |
| ORC-3.4 | Universal ID Type | Indifferent | |
| ORC-10 | Entered By | ||
| ORC-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| ORC-10.2 | Family Name | ||
| ORC-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| ORC-10.2.2 | Own Surname Prefix | ||
| ORC-10.2.3 | Own Surname | ||
| ORC-10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-10.2.5 | Surname From Partner/Spouse | ||
| ORC-10.3 | Given Name | Lily | Presence-Content Indifferent |
| ORC-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| ORC-10.9 | Assigning Authority | ||
| ORC-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-10.9.2 | Universal ID | ||
| ORC-10.9.3 | Universal ID Type | ||
| ORC-10.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-10.12 | Check Digit Scheme | Indifferent | |
| ORC-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| ORC-12 | Ordering Provider | ||
| ORC-12.1 | ID Number | 654 | Presence-Content Indifferent |
| ORC-12.2 | Family Name | ||
| ORC-12.2.1 | Surname | Thomas | Presence-Content Indifferent |
| ORC-12.2.2 | Own Surname Prefix | ||
| ORC-12.2.3 | Own Surname | ||
| ORC-12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-12.2.5 | Surname From Partner/Spouse | ||
| ORC-12.3 | Given Name | Wilma | Presence-Content Indifferent |
| ORC-12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | Presence-Content Indifferent |
| ORC-12.9 | Assigning Authority | ||
| ORC-12.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-12.9.2 | Universal ID | ||
| ORC-12.9.3 | Universal ID Type | ||
| ORC-12.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-12.12 | Check Digit Scheme | Indifferent | |
| ORC-12.13 | Identifier Type Code | MD | Presence-Content Indifferent |
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | wcEHR | Presence-Content Indifferent |
| ORC-17.2 | Text | West Clinic | Presence-Content Indifferent |
| ORC-17.3 | Name of Coding System | HL70362 | Value-Profile Fixed |
| ORC-17.5 | Alternate Text | Indifferent | |
| ORC-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | Value-Profile Fixed |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | 7491 | Presence-Content Indifferent |
| ORC-2.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-2.3 | Universal ID | Indifferent | |
| ORC-2.4 | Universal ID Type | Indifferent | |
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 79539 | Presence-Content Indifferent |
| ORC-3.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-3.3 | Universal ID | Indifferent | |
| ORC-3.4 | Universal ID Type | Indifferent | |
| ORC-10 | Entered By | ||
| ORC-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| ORC-10.2 | Family Name | ||
| ORC-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| ORC-10.2.2 | Own Surname Prefix | ||
| ORC-10.2.3 | Own Surname | ||
| ORC-10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-10.2.5 | Surname From Partner/Spouse | ||
| ORC-10.3 | Given Name | Lily | Presence-Content Indifferent |
| ORC-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| ORC-10.9 | Assigning Authority | ||
| ORC-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-10.9.2 | Universal ID | ||
| ORC-10.9.3 | Universal ID Type | ||
| ORC-10.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-10.12 | Check Digit Scheme | Indifferent | |
| ORC-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| ORC-12 | Ordering Provider | ||
| ORC-12.1 | ID Number | 654 | Presence-Content Indifferent |
| ORC-12.2 | Family Name | ||
| ORC-12.2.1 | Surname | Thomas | Presence-Content Indifferent |
| ORC-12.2.2 | Own Surname Prefix | ||
| ORC-12.2.3 | Own Surname | ||
| ORC-12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-12.2.5 | Surname From Partner/Spouse | ||
| ORC-12.3 | Given Name | Wilma | Presence-Content Indifferent |
| ORC-12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | Presence-Content Indifferent |
| ORC-12.9 | Assigning Authority | ||
| ORC-12.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-12.9.2 | Universal ID | ||
| ORC-12.9.3 | Universal ID Type | ||
| ORC-12.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-12.12 | Check Digit Scheme | Indifferent | |
| ORC-12.13 | Identifier Type Code | MD | Presence-Content Indifferent |
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | wcEHR | Presence-Content Indifferent |
| ORC-17.2 | Text | West Clinic | Presence-Content Indifferent |
| ORC-17.3 | Name of Coding System | HL70362 | Value-Profile Fixed |
| ORC-17.5 | Alternate Text | Indifferent | |
| ORC-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | Value-Profile Fixed |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | 9077 | Presence-Content Indifferent |
| ORC-2.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-2.3 | Universal ID | Indifferent | |
| ORC-2.4 | Universal ID Type | Indifferent | |
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 31528 | Presence-Content Indifferent |
| ORC-3.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-3.3 | Universal ID | Indifferent | |
| ORC-3.4 | Universal ID Type | Indifferent | |
| ORC-10 | Entered By | ||
| ORC-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| ORC-10.2 | Family Name | ||
| ORC-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| ORC-10.2.2 | Own Surname Prefix | ||
| ORC-10.2.3 | Own Surname | ||
| ORC-10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-10.2.5 | Surname From Partner/Spouse | ||
| ORC-10.3 | Given Name | Lily | Presence-Content Indifferent |
| ORC-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| ORC-10.9 | Assigning Authority | ||
| ORC-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-10.9.2 | Universal ID | ||
| ORC-10.9.3 | Universal ID Type | ||
| ORC-10.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-10.12 | Check Digit Scheme | Indifferent | |
| ORC-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| ORC-12 | Ordering Provider | ||
| ORC-12.1 | ID Number | Indifferent | |
| ORC-12.2 | Family Name | ||
| ORC-12.2.1 | Surname | Indifferent | |
| ORC-12.2.2 | Own Surname Prefix | ||
| ORC-12.2.3 | Own Surname | ||
| ORC-12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-12.2.5 | Surname From Partner/Spouse | ||
| ORC-12.3 | Given Name | Indifferent | |
| ORC-12.4 | Second and Further Given Names or Initials Thereof | Indifferent | |
| ORC-12.9 | Assigning Authority | ||
| ORC-12.9.1 | Namespace ID | Indifferent | |
| ORC-12.9.2 | Universal ID | ||
| ORC-12.9.3 | Universal ID Type | ||
| ORC-12.10 | Name Type Code | Indifferent | |
| ORC-12.12 | Check Digit Scheme | Indifferent | |
| ORC-12.13 | Identifier Type Code | Indifferent | |
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | wcEHR | Presence-Content Indifferent |
| ORC-17.2 | Text | West Clinic | Presence-Content Indifferent |
| ORC-17.3 | Name of Coding System | HL70362 | Value-Profile Fixed |
| ORC-17.5 | Alternate Text | Indifferent | |
| ORC-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | Value-Profile Fixed |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | 299 | Presence-Content Indifferent |
| ORC-2.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-2.3 | Universal ID | Indifferent | |
| ORC-2.4 | Universal ID Type | Indifferent | |
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 82668 | Presence-Content Indifferent |
| ORC-3.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-3.3 | Universal ID | Indifferent | |
| ORC-3.4 | Universal ID Type | Indifferent | |
| ORC-10 | Entered By | ||
| ORC-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| ORC-10.2 | Family Name | ||
| ORC-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| ORC-10.2.2 | Own Surname Prefix | ||
| ORC-10.2.3 | Own Surname | ||
| ORC-10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-10.2.5 | Surname From Partner/Spouse | ||
| ORC-10.3 | Given Name | Lily | Presence-Content Indifferent |
| ORC-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| ORC-10.9 | Assigning Authority | ||
| ORC-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-10.9.2 | Universal ID | ||
| ORC-10.9.3 | Universal ID Type | ||
| ORC-10.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-10.12 | Check Digit Scheme | Indifferent | |
| ORC-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| ORC-12 | Ordering Provider | ||
| ORC-12.1 | ID Number | Indifferent | |
| ORC-12.2 | Family Name | ||
| ORC-12.2.1 | Surname | Indifferent | |
| ORC-12.2.2 | Own Surname Prefix | ||
| ORC-12.2.3 | Own Surname | ||
| ORC-12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-12.2.5 | Surname From Partner/Spouse | ||
| ORC-12.3 | Given Name | Indifferent | |
| ORC-12.4 | Second and Further Given Names or Initials Thereof | Indifferent | |
| ORC-12.9 | Assigning Authority | ||
| ORC-12.9.1 | Namespace ID | Indifferent | |
| ORC-12.9.2 | Universal ID | ||
| ORC-12.9.3 | Universal ID Type | ||
| ORC-12.10 | Name Type Code | Indifferent | |
| ORC-12.12 | Check Digit Scheme | Indifferent | |
| ORC-12.13 | Identifier Type Code | Indifferent | |
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | wcEHR | Presence-Content Indifferent |
| ORC-17.2 | Text | West Clinic | Presence-Content Indifferent |
| ORC-17.3 | Name of Coding System | HL70362 | Value-Profile Fixed |
| ORC-17.5 | Alternate Text | Indifferent | |
| ORC-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | Value-Profile Fixed |
| RXA-2 | Administration Sub-ID Counter | 1 | Value-Profile Fixed |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20150624 | Presence-Content Indifferent |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 49281-0560-05 | Value-Test Case Fixed |
| RXA-5.2 | Text | Pentacel | Presence-Content Indifferent |
| RXA-5.3 | Name of Coding System | NDC | Value-Test Case Fixed |
| RXA-5.5 | Alternate Text | Indifferent | |
| RXA-5.6 | Name of Alternate Coding System | Indifferent | |
| RXA-6 | Administered Amount | 0.5 | Value-Test Case Fixed |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | mL | Value-Test Case Fixed |
| RXA-7.2 | Text | mL | Presence-Content Indifferent |
| RXA-7.3 | Name of Coding System | UCUM | Value-Test Case Fixed |
| RXA-7.5 | Alternate Text | Indifferent | |
| RXA-7.6 | Name of Alternate Coding System | Indifferent | |
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 00 | Value-Test Case Fixed |
| RXA-9.2 | Text | New Record | Presence-Content Indifferent |
| RXA-9.3 | Name of Coding System | NIP001 | Value-Profile Fixed |
| RXA-9.5 | Alternate Text | Indifferent | |
| RXA-9.6 | Name of Alternate Coding System | Indifferent | |
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Lily | Presence-Content Indifferent |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | L | Presence-Content Indifferent |
| RXA-10.12 | Check Digit Scheme | Indifferent | |
| RXA-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-11.4.2 | Universal ID | Indifferent | |
| RXA-11.4.3 | Universal ID Type | Indifferent | |
| RXA-15 | Substance Lot Number | 526434 | Presence-Content Indifferent |
| RXA-16 | Substance Expiration Date | ||
| RXA-16.1 | Time | 20150722 | Presence-Content Indifferent |
| RXA-17 | Substance Manufacturer Name | ||
| RXA-17.1 | Identifier | SKB | Presence-Content Indifferent |
| RXA-17.2 | Text | GlaxoSmithKline | Presence-Content Indifferent |
| RXA-17.3 | Name of Coding System | MVX | Value-Test Case Fixed |
| RXA-17.5 | Alternate Text | Indifferent | |
| RXA-17.6 | Name of Alternate Coding System | Indifferent | |
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | Indifferent | |
| RXA-18.2 | Text | Indifferent | |
| RXA-18.3 | Name of Coding System | Indifferent | |
| RXA-18.5 | Alternate Text | Indifferent | |
| RXA-18.6 | Name of Alternate Coding System | Indifferent | |
| RXA-20 | Completion Status | CP | Value-Test Case Fixed |
| RXA-21 | Action Code - RXA | A | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | Value-Profile Fixed |
| RXA-2 | Administration Sub-ID Counter | 1 | Value-Profile Fixed |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20150624 | Presence-Content Indifferent |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 00006-4047-20 | Value-Test Case Fixed |
| RXA-5.2 | Text | RotaTeq | Presence-Content Indifferent |
| RXA-5.3 | Name of Coding System | NDC | Value-Test Case Fixed |
| RXA-5.5 | Alternate Text | Indifferent | |
| RXA-5.6 | Name of Alternate Coding System | Indifferent | |
| RXA-6 | Administered Amount | 2.0 | Value-Test Case Fixed |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | mL | Value-Test Case Fixed |
| RXA-7.2 | Text | mL | Presence-Content Indifferent |
| RXA-7.3 | Name of Coding System | UCUM | Value-Test Case Fixed |
| RXA-7.5 | Alternate Text | Indifferent | |
| RXA-7.6 | Name of Alternate Coding System | Indifferent | |
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 00 | Value-Test Case Fixed |
| RXA-9.2 | Text | New Record | Presence-Content Indifferent |
| RXA-9.3 | Name of Coding System | NIP001 | Value-Profile Fixed |
| RXA-9.5 | Alternate Text | Indifferent | |
| RXA-9.6 | Name of Alternate Coding System | Indifferent | |
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Lily | Presence-Content Indifferent |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | L | Presence-Content Indifferent |
| RXA-10.12 | Check Digit Scheme | Indifferent | |
| RXA-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-11.4.2 | Universal ID | Indifferent | |
| RXA-11.4.3 | Universal ID Type | Indifferent | |
| RXA-15 | Substance Lot Number | 297961 | Presence-Content Indifferent |
| RXA-16 | Substance Expiration Date | ||
| RXA-16.1 | Time | 20150916 | Presence-Content Indifferent |
| RXA-17 | Substance Manufacturer Name | ||
| RXA-17.1 | Identifier | MSD | Presence-Content Indifferent |
| RXA-17.2 | Text | Merck and Co., Inc. | Presence-Content Indifferent |
| RXA-17.3 | Name of Coding System | MVX | Value-Test Case Fixed |
| RXA-17.5 | Alternate Text | Indifferent | |
| RXA-17.6 | Name of Alternate Coding System | Indifferent | |
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | Indifferent | |
| RXA-18.2 | Text | Indifferent | |
| RXA-18.3 | Name of Coding System | Indifferent | |
| RXA-18.5 | Alternate Text | Indifferent | |
| RXA-18.6 | Name of Alternate Coding System | Indifferent | |
| RXA-20 | Completion Status | CP | Value-Test Case Fixed |
| RXA-21 | Action Code - RXA | A | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | Value-Profile Fixed |
| RXA-2 | Administration Sub-ID Counter | 1 | Value-Profile Fixed |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20150624 | Presence-Content Indifferent |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 00005-1971-01 | Value-Test Case Fixed |
| RXA-5.2 | Text | Prevnar 13 | Presence-Content Indifferent |
| RXA-5.3 | Name of Coding System | NDC | Value-Test Case Fixed |
| RXA-5.5 | Alternate Text | Indifferent | |
| RXA-5.6 | Name of Alternate Coding System | Indifferent | |
| RXA-6 | Administered Amount | 0.5 | Value-Test Case Fixed |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | mL | Value-Test Case Fixed |
| RXA-7.2 | Text | mL | Presence-Content Indifferent |
| RXA-7.3 | Name of Coding System | UCUM | Value-Test Case Fixed |
| RXA-7.5 | Alternate Text | Indifferent | |
| RXA-7.6 | Name of Alternate Coding System | Indifferent | |
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 00 | Value-Test Case Fixed |
| RXA-9.2 | Text | New Record | Presence-Content Indifferent |
| RXA-9.3 | Name of Coding System | NIP001 | Value-Profile Fixed |
| RXA-9.5 | Alternate Text | Indifferent | |
| RXA-9.6 | Name of Alternate Coding System | Indifferent | |
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Lily | Presence-Content Indifferent |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | L | Presence-Content Indifferent |
| RXA-10.12 | Check Digit Scheme | Indifferent | |
| RXA-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-11.4.2 | Universal ID | Indifferent | |
| RXA-11.4.3 | Universal ID Type | Indifferent | |
| RXA-15 | Substance Lot Number | 353480 | Presence-Content Indifferent |
| RXA-16 | Substance Expiration Date | ||
| RXA-16.1 | Time | 20150729 | Presence-Content Indifferent |
| RXA-17 | Substance Manufacturer Name | ||
| RXA-17.1 | Identifier | PFR | Presence-Content Indifferent |
| RXA-17.2 | Text | Pfizer, Inc | Presence-Content Indifferent |
| RXA-17.3 | Name of Coding System | MVX | Value-Test Case Fixed |
| RXA-17.5 | Alternate Text | Indifferent | |
| RXA-17.6 | Name of Alternate Coding System | Indifferent | |
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | Indifferent | |
| RXA-18.2 | Text | Indifferent | |
| RXA-18.3 | Name of Coding System | Indifferent | |
| RXA-18.5 | Alternate Text | Indifferent | |
| RXA-18.6 | Name of Alternate Coding System | Indifferent | |
| RXA-20 | Completion Status | CP | Value-Test Case Fixed |
| RXA-21 | Action Code - RXA | A | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | Value-Profile Fixed |
| RXA-2 | Administration Sub-ID Counter | 1 | Value-Profile Fixed |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20150416 | Presence-Content Indifferent |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 45 | Value-Test Case Fixed |
| RXA-5.2 | Text | Hep B, unspecified formulation | Presence-Content Indifferent |
| RXA-5.3 | Name of Coding System | CVX | Value-Test Case Fixed |
| RXA-5.5 | Alternate Text | Indifferent | |
| RXA-5.6 | Name of Alternate Coding System | Indifferent | |
| RXA-6 | Administered Amount | 999 | Value-Test Case Fixed |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | NonPresence | |
| RXA-7.2 | Text | NonPresence | |
| RXA-7.3 | Name of Coding System | NonPresence | |
| RXA-7.5 | Alternate Text | NonPresence | |
| RXA-7.6 | Name of Alternate Coding System | NonPresence | |
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 01 | Value-Test Case Fixed |
| RXA-9.2 | Text | Historical Administration | Presence-Content Indifferent |
| RXA-9.3 | Name of Coding System | NIP001 | Value-Profile Fixed |
| RXA-9.5 | Alternate Text | Indifferent | |
| RXA-9.6 | Name of Alternate Coding System | Indifferent | |
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | Indifferent | |
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Indifferent | |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Indifferent | |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | Indifferent | |
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | Indifferent | |
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | Indifferent | |
| RXA-10.12 | Check Digit Scheme | Indifferent | |
| RXA-10.13 | Identifier Type Code | Indifferent | |
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | Indifferent | |
| RXA-11.4.2 | Universal ID | Indifferent | |
| RXA-11.4.3 | Universal ID Type | Indifferent | |
| RXA-15 | Substance Lot Number | Indifferent | |
| RXA-16 | Substance Expiration Date | ||
| RXA-16.1 | Time | Indifferent | |
| RXA-17 | Substance Manufacturer Name | ||
| RXA-17.1 | Identifier | Indifferent | |
| RXA-17.2 | Text | Indifferent | |
| RXA-17.3 | Name of Coding System | Indifferent | |
| RXA-17.5 | Alternate Text | Indifferent | |
| RXA-17.6 | Name of Alternate Coding System | Indifferent | |
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | Indifferent | |
| RXA-18.2 | Text | Indifferent | |
| RXA-18.3 | Name of Coding System | Indifferent | |
| RXA-18.5 | Alternate Text | Indifferent | |
| RXA-18.6 | Name of Alternate Coding System | Indifferent | |
| RXA-20 | Completion Status | CP | Value-Test Case Fixed |
| RXA-21 | Action Code - RXA | A | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | Value-Profile Fixed |
| RXA-2 | Administration Sub-ID Counter | 1 | Value-Profile Fixed |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20150515 | Presence-Content Indifferent |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 45 | Value-Test Case Fixed |
| RXA-5.2 | Text | Hep B, unspecified formulation | Presence-Content Indifferent |
| RXA-5.3 | Name of Coding System | CVX | Value-Test Case Fixed |
| RXA-5.5 | Alternate Text | Indifferent | |
| RXA-5.6 | Name of Alternate Coding System | Indifferent | |
| RXA-6 | Administered Amount | 999 | Value-Test Case Fixed |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | NonPresence | |
| RXA-7.2 | Text | NonPresence | |
| RXA-7.3 | Name of Coding System | NonPresence | |
| RXA-7.5 | Alternate Text | NonPresence | |
| RXA-7.6 | Name of Alternate Coding System | NonPresence | |
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 01 | Value-Test Case Fixed |
| RXA-9.2 | Text | Historical Administration | Presence-Content Indifferent |
| RXA-9.3 | Name of Coding System | NIP001 | Value-Profile Fixed |
| RXA-9.5 | Alternate Text | Indifferent | |
| RXA-9.6 | Name of Alternate Coding System | Indifferent | |
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | Indifferent | |
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Indifferent | |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Indifferent | |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | Indifferent | |
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | Indifferent | |
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | Indifferent | |
| RXA-10.12 | Check Digit Scheme | Indifferent | |
| RXA-10.13 | Identifier Type Code | Indifferent | |
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | Indifferent | |
| RXA-11.4.2 | Universal ID | Indifferent | |
| RXA-11.4.3 | Universal ID Type | Indifferent | |
| RXA-15 | Substance Lot Number | Indifferent | |
| RXA-16 | Substance Expiration Date | ||
| RXA-16.1 | Time | Indifferent | |
| RXA-17 | Substance Manufacturer Name | ||
| RXA-17.1 | Identifier | Indifferent | |
| RXA-17.2 | Text | Indifferent | |
| RXA-17.3 | Name of Coding System | Indifferent | |
| RXA-17.5 | Alternate Text | Indifferent | |
| RXA-17.6 | Name of Alternate Coding System | Indifferent | |
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | Indifferent | |
| RXA-18.2 | Text | Indifferent | |
| RXA-18.3 | Name of Coding System | Indifferent | |
| RXA-18.5 | Alternate Text | Indifferent | |
| RXA-18.6 | Name of Alternate Coding System | Indifferent | |
| RXA-20 | Completion Status | CP | Value-Test Case Fixed |
| RXA-21 | Action Code - RXA | A | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR-1 | Route | ||
| RXR-1.1 | Identifier | C28161 | Presence-Content Indifferent |
| RXR-1.2 | Text | Intramuscular | Presence-Content Indifferent |
| RXR-1.3 | Name of Coding System | NCIT | Value-Profile Fixed |
| RXR-1.5 | Alternate Text | Indifferent | |
| RXR-1.6 | Name of Alternate Coding System | Indifferent | |
| RXR-2 | Administration Site | ||
| RXR-2.1 | Identifier | RT | Presence-Content Indifferent |
| RXR-2.2 | Text | Right Thigh | Presence-Content Indifferent |
| RXR-2.3 | Name of Coding System | HL70163 | Value-Profile Fixed |
| RXR-2.5 | Alternate Text | Indifferent | |
| RXR-2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR-1 | Route | ||
| RXR-1.1 | Identifier | C38288 | Presence-Content Indifferent |
| RXR-1.2 | Text | Oral | Presence-Content Indifferent |
| RXR-1.3 | Name of Coding System | NCIT | Value-Profile Fixed |
| RXR-1.5 | Alternate Text | Indifferent | |
| RXR-1.6 | Name of Alternate Coding System | Indifferent | |
| RXR-2 | Administration Site | ||
| RXR-2.1 | Identifier | Presence-Content Indifferent | |
| RXR-2.2 | Text | Presence-Content Indifferent | |
| RXR-2.3 | Name of Coding System | Value-Profile Fixed | |
| RXR-2.5 | Alternate Text | Indifferent | |
| RXR-2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR-1 | Route | ||
| RXR-1.1 | Identifier | C28161 | Presence-Content Indifferent |
| RXR-1.2 | Text | Intramuscular | Presence-Content Indifferent |
| RXR-1.3 | Name of Coding System | NCIT | Value-Profile Fixed |
| RXR-1.5 | Alternate Text | Indifferent | |
| RXR-1.6 | Name of Alternate Coding System | Indifferent | |
| RXR-2 | Administration Site | ||
| RXR-2.1 | Identifier | LT | Presence-Content Indifferent |
| RXR-2.2 | Text | Left Thigh | Presence-Content Indifferent |
| RXR-2.3 | Name of Coding System | HL70163 | Value-Profile Fixed |
| RXR-2.5 | Alternate Text | Indifferent | |
| RXR-2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 1 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30963-3 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Source | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 1 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 2 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 64994-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Program Eligibility | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 2 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | VXC40 | Value-Test Case Fixed |
| OBX-17.2 | Text | per immunization | Presence-Content Indifferent |
| OBX-17.3 | Name of Coding System | CDCPHINVS | Value-Profile Fixed |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 3 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 69764-9 | Value-Test Case Fixed |
| OBX-3.2 | Text | Document Type | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 4 | Value-Profile Fixed |
| OBX-2 | Value Type | DT | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 29769-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Date Vis Presented | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | 20150624 | Presence-Content Indifferent |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 5 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 69764-9 | Value-Test Case Fixed |
| OBX-3.2 | Text | Document Type | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 4 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 6 | Value-Profile Fixed |
| OBX-2 | Value Type | DT | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 29769-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Date Vis Presented | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 4 | Presence-Content Indifferent |
| OBX-5 | Observation Value | 20150624 | Presence-Content Indifferent |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 7 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 69764-9 | Value-Test Case Fixed |
| OBX-3.2 | Text | Document Type | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 5 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 8 | Value-Profile Fixed |
| OBX-2 | Value Type | DT | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 29769-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Date Vis Presented | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 5 | Presence-Content Indifferent |
| OBX-5 | Observation Value | 20150624 | Presence-Content Indifferent |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 1 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30963-3 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Source | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 1 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 2 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 64994-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Program Eligibility | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 2 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | VXC40 | Value-Test Case Fixed |
| OBX-17.2 | Text | per immunization | Presence-Content Indifferent |
| OBX-17.3 | Name of Coding System | CDCPHINVS | Value-Profile Fixed |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 3 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 69764-9 | Value-Test Case Fixed |
| OBX-3.2 | Text | Document Type | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 4 | Value-Profile Fixed |
| OBX-2 | Value Type | DT | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 29769-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Date Vis Presented | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | 20150624 | Presence-Content Indifferent |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 1 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30963-3 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Source | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 1 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 2 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 64994-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Program Eligibility | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 2 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | VXC40 | Value-Test Case Fixed |
| OBX-17.2 | Text | per immunization | Presence-Content Indifferent |
| OBX-17.3 | Name of Coding System | CDCPHINVS | Value-Profile Fixed |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 3 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 69764-9 | Value-Test Case Fixed |
| OBX-3.2 | Text | Document Type | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 4 | Value-Profile Fixed |
| OBX-2 | Value Type | DT | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 29769-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Date Vis Presented | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | 20150624 | Presence-Content Indifferent |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Element | Data |
|---|---|
| Patient Name | Russell Clint Richardson |
| Mother's Maiden Name | Billington |
| ID Number | 3123 |
| Date/Time of Birth | 04/15/2015 |
| Administrative Sex | Male |
| Patient Address | 543 Blount Drive Bozeman MT 59715 USA |
| Local Number | (406)555-7690 |
| Race | American Indian or Alaska Native |
| Ethnic Group | Not Hispanic or Latino |
| Multiple Birth Indicator | N |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 04/15/2015 |
| Publicity Code | Recall only - no calls |
| Publicity Code Effective Date | 06/24/2015 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 06/24/2015 |
| Element | Data |
|---|---|
| Name | Maria Elizabeth Richardson |
| Relationship | Mother |
| Address | 543 Blount Drive Bozeman MT 59715 USA |
| Phone Number | (406)555-7690 |
| Element | Data |
|---|---|
| Name | John William Richardson |
| Relationship | Father |
| Address | 543 Blount Drive Bozeman MT 59715 USA |
| Phone Number | (406)555-8299 |
| Element | Data |
|---|---|
| Administered Code | Pentacel |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 526434 |
| Substance Expiration Date | 07/22/2015 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Right Thigh |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Public |
| Vaccine Funding Program Eligibility | VFC Eligible - American Indian/Alaska Native |
| Document Type | Polio VIS |
| Date Vis Presented | 06/24/2015 |
| Document Type | Hepatitis B VIS |
| Date Vis Presented | 06/24/2015 |
| Document Type | Diphtheria/Tetanus/Pertussis (DTaP) VIS |
| Date Vis Presented | 06/24/2015 |
| Element | Data |
|---|---|
| Administered Code | RotaTeq |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 2.0 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 297961 |
| Substance Expiration Date | 09/16/2015 |
| Substance Manufacturer Name | Merck and Co., Inc. |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Oral |
| Administration Site | |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Public |
| Vaccine Funding Program Eligibility | VFC Eligible - American Indian/Alaska Native |
| Document Type | Rotavirus VIS |
| Date Vis Presented | 06/24/2015 |
| Element | Data |
|---|---|
| Administered Code | Prevnar 13 |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 353480 |
| Substance Expiration Date | 07/29/2015 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Thigh |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Public |
| Vaccine Funding Program Eligibility | VFC Eligible - American Indian/Alaska Native |
| Document Type | Pneumococcal Conjugate (PCV13) VIS |
| Date Vis Presented | 06/24/2015 |
| Element | Data |
|---|---|
| Administered Code | Hep B, unspecified formulation |
| Date/Time Start of Administration | 04/16/2015 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical Administration |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By |
| Element | Data |
|---|---|
| Administered Code | Hep B, unspecified formulation |
| Date/Time Start of Administration | 05/15/2015 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical Administration |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By |
| Element | Data |
|---|---|
| Patient Name | Russell Clint Richardson |
| Mother's Maiden Name | Billington |
| ID Number | 3123 |
| Date/Time of Birth | 04/15/2015 |
| Administrative Sex | Male |
| Patient Address | 543 Blount Drive Bozeman MT 59715 USA |
| Local Number | (406)555-7690 |
| Race | American Indian or Alaska Native |
| Ethnic Group | Not Hispanic or Latino |
| Multiple Birth Indicator | N |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 04/15/2015 |
| Publicity Code | Recall only - no calls |
| Publicity Code Effective Date | 06/24/2015 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 06/24/2015 |
| Element | Data |
|---|---|
| Name | Maria Elizabeth Richardson |
| Relationship | Mother |
| Address | 543 Blount Drive Bozeman MT 59715 USA |
| Phone Number | (406)555-7690 |
| Element | Data |
|---|---|
| Name | John William Richardson |
| Relationship | Father |
| Address | 543 Blount Drive Bozeman MT 59715 USA |
| Phone Number | (406)555-8299 |
| Element | Data |
|---|---|
| Administered Code | Pentacel |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 526434 |
| Substance Expiration Date | 07/22/2015 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Right Thigh |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Public |
| Vaccine Funding Program Eligibility | VFC Eligible - American Indian/Alaska Native |
| Document Type | Polio VIS |
| Date Vis Presented | 06/24/2015 |
| Document Type | Hepatitis B VIS |
| Date Vis Presented | 06/24/2015 |
| Document Type | Diphtheria/Tetanus/Pertussis (DTaP) VIS |
| Date Vis Presented | 06/24/2015 |
| Element | Data |
|---|---|
| Administered Code | RotaTeq |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 2.0 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 297961 |
| Substance Expiration Date | 09/16/2015 |
| Substance Manufacturer Name | Merck and Co., Inc. |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Oral |
| Administration Site | |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Public |
| Vaccine Funding Program Eligibility | VFC Eligible - American Indian/Alaska Native |
| Document Type | Rotavirus VIS |
| Date Vis Presented | 06/24/2015 |
| Element | Data |
|---|---|
| Administered Code | Prevnar 13 |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 353480 |
| Substance Expiration Date | 07/29/2015 |
| Substance Manufacturer Name | Pfizer, Inc |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Thigh |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Public |
| Vaccine Funding Program Eligibility | VFC Eligible - American Indian/Alaska Native |
| Document Type | Pneumococcal Conjugate (PCV13) VIS |
| Date Vis Presented | 06/24/2015 |
| Element | Data |
|---|---|
| Administered Code | Hep B, unspecified formulation |
| Date/Time Start of Administration | 04/16/2015 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical Administration |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By |
| Element | Data |
|---|---|
| Administered Code | Hep B, unspecified formulation |
| Date/Time Start of Administration | 05/15/2015 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical Administration |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By |
| Description |
|---|
| The IIS returns a positive acknowledgement message indicating that no errors were found during the course of filing the message. |
| Comments |
|---|
| No Comments |
| Pre Condition |
|---|
| A VXU message is generated by the EHR. |
| Post Condition |
|---|
| No PostCondition |
| Test Objectives |
|---|
| No Test Objectives |
| Evaluation Criteria |
|---|
| The acknowledgement message is consumed by the system responsible for the content of the administration message without error. |
| Notes for Testers |
|---|
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | Presence-Content Indifferent | |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | IIS | Presence-Content Indifferent |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | Presence-Content Indifferent | |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150624073734.034-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | ACK | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | ACK | Value-Profile Fixed |
| MSH-10 | Message Control ID | 23628 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z23 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | IIS | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | Indifferent | |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | Indifferent | |
| MSH-22.10 | Organization Identifier | Indifferent | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | wcEHR | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | Indifferent | |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | Indifferent | |
| MSH-23.10 | Organization Identifier | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA-1 | Acknowledgment Code | AA | Value-Test Case Fixed |
| MSA-2 | Message Control ID | 12462 | Presence-System Generated |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | Presence-Content Indifferent | |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | IIS | Presence-Content Indifferent |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | Presence-Content Indifferent | |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150624073734.034-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | ACK | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | ACK | Value-Profile Fixed |
| MSH-10 | Message Control ID | 23628 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z23 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | IIS | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | Indifferent | |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | Indifferent | |
| MSH-22.10 | Organization Identifier | Indifferent | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | wcEHR | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | Indifferent | |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | Indifferent | |
| MSH-23.10 | Organization Identifier | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA-1 | Acknowledgment Code | AA | Value-Test Case Fixed |
| MSA-2 | Message Control ID | 12462 | Presence-System Generated |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Return an Acknowledgement | |||||
|---|---|---|---|---|---|
| Test Case ID | IZ-AD-1_Admin_Chlid | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement (Pass/Fail) |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which NO Error is returned in the message.
The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.
| Return an Acknowledgement |
|---|
|
The receiving HIT system being tested shall process the Z23 ACK message correctly; a positive notification indicating that the ACK message was processed correctly need not be made visible in the system. |
| Description |
|---|
| An adult is seen at a clinic. Historical vaccinations are recorded and new vaccines are administered and documented. |
| Comments |
|---|
| No Comments |
| Pre Condition |
|---|
| No PreCondition |
| Post Condition |
|---|
| No PostCondition |
| Test Objectives |
|---|
| This test case assesses the ability of the EHR to create an administration message for an adult containing historical and new administrations including VIS and not eligible VFC. |
| Evaluation Criteria |
|---|
| Notes for Testers |
|---|
| No Note |
| Description |
|---|
| A 32 year old female, Elise Wong, visits a clinic for a well woman visit. A clinic staff member collects basic patient demographic information including name, date of birth and sex. A clinic provider, Wilma Thomas (physician ID 654) reviews the patient's vaccination history and determines that Elise has received her influenza vaccinations on 10/12/2014 and 11/12/2013, but is in need of a tetanus booster. Because of the patient's age she does not qualify for Vaccine For Children (VFC) supplied vaccine. Elise is given the appropriate Vaccine Information Sheet (VIS) to review. After reading it, she agrees to receive the recommended vaccination. She also agrees that the data should be shared once it is incorporated into the local IIS. An appropriate dose of Tdap (TENIVAC) is selected from the clinic's stock of privately funded vaccines. A clinician, Lily Jackson (ID 7824) prepares and administers the doses to the patient and then enters the data into the EHR and transmits it to the IIS. |
| Comments |
|---|
No Comments |
| Pre Condition |
|---|
| No PreCondition |
| Post Condition |
|---|
| No PostCondition |
| Test Objectives |
|---|
| Evaluation Criteria |
|---|
| Message Validation Report |
| Notes for Testers |
|---|
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | wcApp | Presence-Content Indifferent |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | iisApp | Presence-Content Indifferent |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | IIS | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150624084727.655-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | VXU | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | VXU_V04 | Value-Profile Fixed |
| MSH-10 | Message Control ID | 72268 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | ER | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | AL | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z22 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | wcEHR | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | Indifferent | |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | Indifferent | |
| MSH-22.10 | Organization Identifier | Indifferent | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | IIS | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | Indifferent | |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | Indifferent | |
| MSH-23.10 | Organization Identifier | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID-1 | Set ID - PID | 1 | Value-Profile Fixed |
| PID-3 | Patient Identifier List | ||
| PID-3.1 | ID Number | 90012 | Presence-Content Indifferent |
| PID-3.3 | Check Digit Scheme | Indifferent | |
| PID-3.4 | Assigning Authority | ||
| PID-3.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| PID-3.4.2 | Universal ID | Indifferent | |
| PID-3.4.3 | Universal ID Type | Indifferent | |
| PID-3.5 | Identifier Type Code | MR | Presence-Content Indifferent |
| PID-5 | Patient Name | ||
| PID-5.1 | Family Name | ||
| PID-5.1.1 | Surname | Wong | Presence-Content Indifferent |
| PID-5.1.2 | Own Surname Prefix | ||
| PID-5.1.3 | Own Surname | ||
| PID-5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-5.1.5 | Surname From Partner/Spouse | ||
| PID-5.2 | Given Name | Elise | Presence-Content Indifferent |
| PID-5.3 | Second and Further Given Names or Initials Thereof | Indifferent | |
| PID-5.7 | Name Type Code | L | Presence-Content Indifferent |
| PID-6 | Mother's Maiden Name | ||
| PID-6.1 | Family Name | ||
| PID-6.1.1 | Surname | Indifferent | |
| PID-6.1.2 | Own Surname Prefix | ||
| PID-6.1.3 | Own Surname | ||
| PID-6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-6.1.5 | Surname From Partner/Spouse | ||
| PID-6.7 | Name Type Code | Indifferent | |
| PID-7 | Date/Time of Birth | ||
| PID-7.1 | Time | 19830615 | Presence-Content Indifferent |
| PID-8 | Administrative Sex | F | Presence-Content Indifferent |
| PID-10 | Race | ||
| PID-10.1 | Identifier | 2028-9 | Presence-Content Indifferent |
| PID-10.2 | Text | Asian | Presence-Content Indifferent |
| PID-10.3 | Name of Coding System | CDCREC | Value-Profile Fixed |
| PID-10.5 | Alternate Text | Indifferent | |
| PID-10.6 | Name of Alternate Coding System | Indifferent | |
| PID-11 | Patient Address | ||
| PID-11.1 | Street Address | ||
| PID-11.1.1 | Street or Mailing Address | 9200 Wellington Trail | Presence-Content Indifferent |
| PID-11.1.2 | Street Name | ||
| PID-11.1.3 | Dwelling Number | ||
| PID-11.2 | Other Designation | Indifferent | |
| PID-11.3 | City | Bozeman | Presence-Content Indifferent |
| PID-11.4 | State or Province | MT | Presence-Content Indifferent |
| PID-11.5 | Zip or Postal Code | 59715 | Presence-Content Indifferent |
| PID-11.6 | Country | USA | Presence-Content Indifferent |
| PID-11.7 | Address Type | P | Presence-Content Indifferent |
| PID-13[1] | Phone Number - Home | ||
| PID-13[1].2 | Telecommunication Use Code | PRN | Presence-Content Indifferent |
| PID-13[1].3 | Telecommunication Equipment Type | PH | Value-Test Case Fixed |
| PID-13[1].4 | Email Address | NonPresence | |
| PID-13[1].6 | Area/City Code | 406 | Presence-Content Indifferent |
| PID-13[1].7 | Local Number | 5557896 | Presence-Content Indifferent |
| PID-13[2] | Phone Number - Home | ||
| PID-13[2].2 | Telecommunication Use Code | NET | Value-Test Case Fixed |
| PID-13[2].3 | Telecommunication Equipment Type | Internet | Value-Test Case Fixed |
| PID-13[2].4 | Email Address | Elise.Wong@isp.com | Presence-Content Indifferent |
| PID-13[2].6 | Area/City Code | NonPresence | |
| PID-13[2].7 | Local Number | NonPresence | |
| PID-22 | Ethnic Group | ||
| PID-22.1 | Identifier | 2186-5 | Presence-Content Indifferent |
| PID-22.2 | Text | Not Hispanic or Latino | Presence-Content Indifferent |
| PID-22.3 | Name of Coding System | CDCREC | Value-Profile Fixed |
| PID-22.5 | Alternate Text | Indifferent | |
| PID-22.6 | Name of Alternate Coding System | Indifferent | |
| PID-24 | Multiple Birth Indicator | N | Presence-Content Indifferent |
| PID-25 | Birth Order | 1 | Indifferent |
| PID-29 | Patient Death Date and Time | ||
| PID-29.1 | Time | Indifferent | |
| PID-30 | Patient Death Indicator | N | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1-11 | Publicity Code | ||
| PD1-11.1 | Identifier | 02 | Presence-Content Indifferent |
| PD1-11.2 | Text | Reminder/recall - any method | Presence-Content Indifferent |
| PD1-11.3 | Name of Coding System | HL70215 | Value-Profile Fixed |
| PD1-11.5 | Alternate Text | Indifferent | |
| PD1-11.6 | Name of Alternate Coding System | Indifferent | |
| PD1-12 | Protection Indicator | N | Value-Test Case Fixed |
| PD1-13 | Protection Indicator Effective Date | 20150624 | Presence-Content Indifferent |
| PD1-16 | Immunization Registry Status | A | Presence-Content Indifferent |
| PD1-17 | Immunization Registry Status Effective Date | 19830615 | Presence-Content Indifferent |
| PD1-18 | Publicity Code Effective Date | 20150624 | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | Value-Profile Fixed |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | 4422 | Presence-Content Indifferent |
| ORC-2.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-2.3 | Universal ID | Indifferent | |
| ORC-2.4 | Universal ID Type | Indifferent | |
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 13696 | Presence-Content Indifferent |
| ORC-3.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-3.3 | Universal ID | Indifferent | |
| ORC-3.4 | Universal ID Type | Indifferent | |
| ORC-10 | Entered By | ||
| ORC-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| ORC-10.2 | Family Name | ||
| ORC-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| ORC-10.2.2 | Own Surname Prefix | ||
| ORC-10.2.3 | Own Surname | ||
| ORC-10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-10.2.5 | Surname From Partner/Spouse | ||
| ORC-10.3 | Given Name | Lily | Presence-Content Indifferent |
| ORC-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| ORC-10.9 | Assigning Authority | ||
| ORC-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-10.9.2 | Universal ID | ||
| ORC-10.9.3 | Universal ID Type | ||
| ORC-10.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-10.12 | Check Digit Scheme | Indifferent | |
| ORC-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| ORC-12 | Ordering Provider | ||
| ORC-12.1 | ID Number | 654 | Presence-Content Indifferent |
| ORC-12.2 | Family Name | ||
| ORC-12.2.1 | Surname | Thomas | Presence-Content Indifferent |
| ORC-12.2.2 | Own Surname Prefix | ||
| ORC-12.2.3 | Own Surname | ||
| ORC-12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-12.2.5 | Surname From Partner/Spouse | ||
| ORC-12.3 | Given Name | Wilma | Presence-Content Indifferent |
| ORC-12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | Presence-Content Indifferent |
| ORC-12.9 | Assigning Authority | ||
| ORC-12.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-12.9.2 | Universal ID | ||
| ORC-12.9.3 | Universal ID Type | ||
| ORC-12.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-12.12 | Check Digit Scheme | Indifferent | |
| ORC-12.13 | Identifier Type Code | MD | Presence-Content Indifferent |
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | wcEHR | Presence-Content Indifferent |
| ORC-17.2 | Text | West Clinic | Presence-Content Indifferent |
| ORC-17.3 | Name of Coding System | HL70362 | Value-Profile Fixed |
| ORC-17.5 | Alternate Text | Indifferent | |
| ORC-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | Value-Profile Fixed |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | 6139 | Presence-Content Indifferent |
| ORC-2.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-2.3 | Universal ID | Indifferent | |
| ORC-2.4 | Universal ID Type | Indifferent | |
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 38760 | Presence-Content Indifferent |
| ORC-3.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-3.3 | Universal ID | Indifferent | |
| ORC-3.4 | Universal ID Type | Indifferent | |
| ORC-10 | Entered By | ||
| ORC-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| ORC-10.2 | Family Name | ||
| ORC-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| ORC-10.2.2 | Own Surname Prefix | ||
| ORC-10.2.3 | Own Surname | ||
| ORC-10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-10.2.5 | Surname From Partner/Spouse | ||
| ORC-10.3 | Given Name | Lily | Presence-Content Indifferent |
| ORC-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| ORC-10.9 | Assigning Authority | ||
| ORC-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-10.9.2 | Universal ID | ||
| ORC-10.9.3 | Universal ID Type | ||
| ORC-10.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-10.12 | Check Digit Scheme | Indifferent | |
| ORC-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| ORC-12 | Ordering Provider | ||
| ORC-12.1 | ID Number | Indifferent | |
| ORC-12.2 | Family Name | ||
| ORC-12.2.1 | Surname | Indifferent | |
| ORC-12.2.2 | Own Surname Prefix | ||
| ORC-12.2.3 | Own Surname | ||
| ORC-12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-12.2.5 | Surname From Partner/Spouse | ||
| ORC-12.3 | Given Name | Indifferent | |
| ORC-12.4 | Second and Further Given Names or Initials Thereof | Indifferent | |
| ORC-12.9 | Assigning Authority | ||
| ORC-12.9.1 | Namespace ID | Indifferent | |
| ORC-12.9.2 | Universal ID | ||
| ORC-12.9.3 | Universal ID Type | ||
| ORC-12.10 | Name Type Code | Indifferent | |
| ORC-12.12 | Check Digit Scheme | Indifferent | |
| ORC-12.13 | Identifier Type Code | Indifferent | |
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | wcEHR | Presence-Content Indifferent |
| ORC-17.2 | Text | West Clinic | Presence-Content Indifferent |
| ORC-17.3 | Name of Coding System | HL70362 | Value-Profile Fixed |
| ORC-17.5 | Alternate Text | Indifferent | |
| ORC-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | Value-Profile Fixed |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | 7600 | Presence-Content Indifferent |
| ORC-2.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-2.3 | Universal ID | Indifferent | |
| ORC-2.4 | Universal ID Type | Indifferent | |
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 35508 | Presence-Content Indifferent |
| ORC-3.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-3.3 | Universal ID | Indifferent | |
| ORC-3.4 | Universal ID Type | Indifferent | |
| ORC-10 | Entered By | ||
| ORC-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| ORC-10.2 | Family Name | ||
| ORC-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| ORC-10.2.2 | Own Surname Prefix | ||
| ORC-10.2.3 | Own Surname | ||
| ORC-10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-10.2.5 | Surname From Partner/Spouse | ||
| ORC-10.3 | Given Name | Lily | Presence-Content Indifferent |
| ORC-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| ORC-10.9 | Assigning Authority | ||
| ORC-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-10.9.2 | Universal ID | ||
| ORC-10.9.3 | Universal ID Type | ||
| ORC-10.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-10.12 | Check Digit Scheme | Indifferent | |
| ORC-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| ORC-12 | Ordering Provider | ||
| ORC-12.1 | ID Number | Indifferent | |
| ORC-12.2 | Family Name | ||
| ORC-12.2.1 | Surname | Indifferent | |
| ORC-12.2.2 | Own Surname Prefix | ||
| ORC-12.2.3 | Own Surname | ||
| ORC-12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-12.2.5 | Surname From Partner/Spouse | ||
| ORC-12.3 | Given Name | Indifferent | |
| ORC-12.4 | Second and Further Given Names or Initials Thereof | Indifferent | |
| ORC-12.9 | Assigning Authority | ||
| ORC-12.9.1 | Namespace ID | Indifferent | |
| ORC-12.9.2 | Universal ID | ||
| ORC-12.9.3 | Universal ID Type | ||
| ORC-12.10 | Name Type Code | Indifferent | |
| ORC-12.12 | Check Digit Scheme | Indifferent | |
| ORC-12.13 | Identifier Type Code | Indifferent | |
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | wcEHR | Presence-Content Indifferent |
| ORC-17.2 | Text | West Clinic | Presence-Content Indifferent |
| ORC-17.3 | Name of Coding System | HL70362 | Value-Profile Fixed |
| ORC-17.5 | Alternate Text | Indifferent | |
| ORC-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | Value-Profile Fixed |
| RXA-2 | Administration Sub-ID Counter | 1 | Value-Profile Fixed |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20150624 | Presence-Content Indifferent |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 49281-0215-88 | Value-Test Case Fixed |
| RXA-5.2 | Text | TENIVAC | Presence-Content Indifferent |
| RXA-5.3 | Name of Coding System | NDC | Value-Test Case Fixed |
| RXA-5.5 | Alternate Text | Indifferent | |
| RXA-5.6 | Name of Alternate Coding System | Indifferent | |
| RXA-6 | Administered Amount | 0.5 | Value-Test Case Fixed |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | mL | Value-Test Case Fixed |
| RXA-7.2 | Text | mL | Presence-Content Indifferent |
| RXA-7.3 | Name of Coding System | UCUM | Value-Test Case Fixed |
| RXA-7.5 | Alternate Text | Indifferent | |
| RXA-7.6 | Name of Alternate Coding System | Indifferent | |
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 00 | Value-Test Case Fixed |
| RXA-9.2 | Text | New Record | Presence-Content Indifferent |
| RXA-9.3 | Name of Coding System | NIP001 | Value-Profile Fixed |
| RXA-9.5 | Alternate Text | Indifferent | |
| RXA-9.6 | Name of Alternate Coding System | Indifferent | |
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Lily | Presence-Content Indifferent |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | L | Presence-Content Indifferent |
| RXA-10.12 | Check Digit Scheme | Indifferent | |
| RXA-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-11.4.2 | Universal ID | Indifferent | |
| RXA-11.4.3 | Universal ID Type | Indifferent | |
| RXA-15 | Substance Lot Number | 315841 | Presence-Content Indifferent |
| RXA-16 | Substance Expiration Date | ||
| RXA-16.1 | Time | 20151216 | Presence-Content Indifferent |
| RXA-17 | Substance Manufacturer Name | ||
| RXA-17.1 | Identifier | PMC | Presence-Content Indifferent |
| RXA-17.2 | Text | Sanofi Pasteur | Presence-Content Indifferent |
| RXA-17.3 | Name of Coding System | MVX | Value-Test Case Fixed |
| RXA-17.5 | Alternate Text | Indifferent | |
| RXA-17.6 | Name of Alternate Coding System | Indifferent | |
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | Indifferent | |
| RXA-18.2 | Text | Indifferent | |
| RXA-18.3 | Name of Coding System | Indifferent | |
| RXA-18.5 | Alternate Text | Indifferent | |
| RXA-18.6 | Name of Alternate Coding System | Indifferent | |
| RXA-20 | Completion Status | CP | Value-Test Case Fixed |
| RXA-21 | Action Code - RXA | A | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | Value-Profile Fixed |
| RXA-2 | Administration Sub-ID Counter | 1 | Value-Profile Fixed |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20141012 | Presence-Content Indifferent |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 88 | Value-Test Case Fixed |
| RXA-5.2 | Text | influenza, unspecified formulation | Presence-Content Indifferent |
| RXA-5.3 | Name of Coding System | CVX | Value-Test Case Fixed |
| RXA-5.5 | Alternate Text | Indifferent | |
| RXA-5.6 | Name of Alternate Coding System | Indifferent | |
| RXA-6 | Administered Amount | 999 | Value-Test Case Fixed |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | NonPresence | |
| RXA-7.2 | Text | NonPresence | |
| RXA-7.3 | Name of Coding System | NonPresence | |
| RXA-7.5 | Alternate Text | NonPresence | |
| RXA-7.6 | Name of Alternate Coding System | NonPresence | |
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 01 | Value-Test Case Fixed |
| RXA-9.2 | Text | Historical Administration | Presence-Content Indifferent |
| RXA-9.3 | Name of Coding System | NIP001 | Value-Profile Fixed |
| RXA-9.5 | Alternate Text | Indifferent | |
| RXA-9.6 | Name of Alternate Coding System | Indifferent | |
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | Indifferent | |
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Indifferent | |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Indifferent | |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | Indifferent | |
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | Indifferent | |
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | Indifferent | |
| RXA-10.12 | Check Digit Scheme | Indifferent | |
| RXA-10.13 | Identifier Type Code | Indifferent | |
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | Indifferent | |
| RXA-11.4.2 | Universal ID | Indifferent | |
| RXA-11.4.3 | Universal ID Type | Indifferent | |
| RXA-15 | Substance Lot Number | Indifferent | |
| RXA-16 | Substance Expiration Date | ||
| RXA-16.1 | Time | Indifferent | |
| RXA-17 | Substance Manufacturer Name | ||
| RXA-17.1 | Identifier | Indifferent | |
| RXA-17.2 | Text | Indifferent | |
| RXA-17.3 | Name of Coding System | Indifferent | |
| RXA-17.5 | Alternate Text | Indifferent | |
| RXA-17.6 | Name of Alternate Coding System | Indifferent | |
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | Indifferent | |
| RXA-18.2 | Text | Indifferent | |
| RXA-18.3 | Name of Coding System | Indifferent | |
| RXA-18.5 | Alternate Text | Indifferent | |
| RXA-18.6 | Name of Alternate Coding System | Indifferent | |
| RXA-20 | Completion Status | CP | Value-Test Case Fixed |
| RXA-21 | Action Code - RXA | A | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | Value-Profile Fixed |
| RXA-2 | Administration Sub-ID Counter | 1 | Value-Profile Fixed |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20131112 | Presence-Content Indifferent |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 88 | Value-Test Case Fixed |
| RXA-5.2 | Text | influenza, unspecified formulation | Presence-Content Indifferent |
| RXA-5.3 | Name of Coding System | CVX | Value-Test Case Fixed |
| RXA-5.5 | Alternate Text | Indifferent | |
| RXA-5.6 | Name of Alternate Coding System | Indifferent | |
| RXA-6 | Administered Amount | 999 | Value-Test Case Fixed |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | NonPresence | |
| RXA-7.2 | Text | NonPresence | |
| RXA-7.3 | Name of Coding System | NonPresence | |
| RXA-7.5 | Alternate Text | NonPresence | |
| RXA-7.6 | Name of Alternate Coding System | NonPresence | |
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 01 | Value-Test Case Fixed |
| RXA-9.2 | Text | Historical Administration | Presence-Content Indifferent |
| RXA-9.3 | Name of Coding System | NIP001 | Value-Profile Fixed |
| RXA-9.5 | Alternate Text | Indifferent | |
| RXA-9.6 | Name of Alternate Coding System | Indifferent | |
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | Indifferent | |
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Indifferent | |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Indifferent | |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | Indifferent | |
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | Indifferent | |
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | Indifferent | |
| RXA-10.12 | Check Digit Scheme | Indifferent | |
| RXA-10.13 | Identifier Type Code | Indifferent | |
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | Indifferent | |
| RXA-11.4.2 | Universal ID | Indifferent | |
| RXA-11.4.3 | Universal ID Type | Indifferent | |
| RXA-15 | Substance Lot Number | Indifferent | |
| RXA-16 | Substance Expiration Date | ||
| RXA-16.1 | Time | Indifferent | |
| RXA-17 | Substance Manufacturer Name | ||
| RXA-17.1 | Identifier | Indifferent | |
| RXA-17.2 | Text | Indifferent | |
| RXA-17.3 | Name of Coding System | Indifferent | |
| RXA-17.5 | Alternate Text | Indifferent | |
| RXA-17.6 | Name of Alternate Coding System | Indifferent | |
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | Indifferent | |
| RXA-18.2 | Text | Indifferent | |
| RXA-18.3 | Name of Coding System | Indifferent | |
| RXA-18.5 | Alternate Text | Indifferent | |
| RXA-18.6 | Name of Alternate Coding System | Indifferent | |
| RXA-20 | Completion Status | CP | Value-Test Case Fixed |
| RXA-21 | Action Code - RXA | A | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR-1 | Route | ||
| RXR-1.1 | Identifier | C28161 | Presence-Content Indifferent |
| RXR-1.2 | Text | Intramuscular | Presence-Content Indifferent |
| RXR-1.3 | Name of Coding System | NCIT | Value-Profile Fixed |
| RXR-1.5 | Alternate Text | Indifferent | |
| RXR-1.6 | Name of Alternate Coding System | Indifferent | |
| RXR-2 | Administration Site | ||
| RXR-2.1 | Identifier | RD | Presence-Content Indifferent |
| RXR-2.2 | Text | Right Deltoid | Presence-Content Indifferent |
| RXR-2.3 | Name of Coding System | HL70163 | Value-Profile Fixed |
| RXR-2.5 | Alternate Text | Indifferent | |
| RXR-2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 1 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30963-3 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Source | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 1 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-5.1 | Identifier | PHC70 | |
| OBX-5.2 | Text | Private | |
| OBX-5.3 | Name of Coding System | CDCPHINVS | |
| OBX-5.5 | Alternate Text | ||
| OBX-5.6 | Name of Alternate Coding System | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 2 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 64994-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Program Eligibility | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 2 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-5.1 | Identifier | V01 | |
| OBX-5.2 | Text | Not VFC Eligible | |
| OBX-5.3 | Name of Coding System | HL70064 | |
| OBX-5.5 | Alternate Text | ||
| OBX-5.6 | Name of Alternate Coding System | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | VXC40 | Value-Test Case Fixed |
| OBX-17.2 | Text | per immunization | Presence-Content Indifferent |
| OBX-17.3 | Name of Coding System | CDCPHINVS | Value-Profile Fixed |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 3 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 69764-9 | Value-Test Case Fixed |
| OBX-3.2 | Text | Document Type | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-5.1 | Identifier | 253088698300028811150224 | |
| OBX-5.2 | Text | Tetanus/Diphtheria (Td) VIS | |
| OBX-5.3 | Name of Coding System | cdcgs1vis | |
| OBX-5.5 | Alternate Text | ||
| OBX-5.6 | Name of Alternate Coding System | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 4 | Value-Profile Fixed |
| OBX-2 | Value Type | DT | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 29769-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Date Vis Presented | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | 20150624 | Presence-Content Indifferent |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | wcApp | Presence-Content Indifferent |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | iisApp | Presence-Content Indifferent |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | IIS | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150624084727.655-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | VXU | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | VXU_V04 | Value-Profile Fixed |
| MSH-10 | Message Control ID | 72268 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | ER | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | AL | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z22 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | wcEHR | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | Indifferent | |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | Indifferent | |
| MSH-22.10 | Organization Identifier | Indifferent | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | IIS | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | Indifferent | |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | Indifferent | |
| MSH-23.10 | Organization Identifier | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID-1 | Set ID - PID | 1 | Value-Profile Fixed |
| PID-3 | Patient Identifier List | ||
| PID-3.1 | ID Number | 90012 | Presence-Content Indifferent |
| PID-3.3 | Check Digit Scheme | Indifferent | |
| PID-3.4 | Assigning Authority | ||
| PID-3.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| PID-3.4.2 | Universal ID | Indifferent | |
| PID-3.4.3 | Universal ID Type | Indifferent | |
| PID-3.5 | Identifier Type Code | MR | Presence-Content Indifferent |
| PID-5 | Patient Name | ||
| PID-5.1 | Family Name | ||
| PID-5.1.1 | Surname | Wong | Presence-Content Indifferent |
| PID-5.1.2 | Own Surname Prefix | ||
| PID-5.1.3 | Own Surname | ||
| PID-5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-5.1.5 | Surname From Partner/Spouse | ||
| PID-5.2 | Given Name | Elise | Presence-Content Indifferent |
| PID-5.3 | Second and Further Given Names or Initials Thereof | Indifferent | |
| PID-5.7 | Name Type Code | L | Presence-Content Indifferent |
| PID-6 | Mother's Maiden Name | ||
| PID-6.1 | Family Name | ||
| PID-6.1.1 | Surname | Indifferent | |
| PID-6.1.2 | Own Surname Prefix | ||
| PID-6.1.3 | Own Surname | ||
| PID-6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-6.1.5 | Surname From Partner/Spouse | ||
| PID-6.7 | Name Type Code | Indifferent | |
| PID-7 | Date/Time of Birth | ||
| PID-7.1 | Time | 19830615 | Presence-Content Indifferent |
| PID-8 | Administrative Sex | F | Presence-Content Indifferent |
| PID-10 | Race | ||
| PID-10.1 | Identifier | 2028-9 | Presence-Content Indifferent |
| PID-10.2 | Text | Asian | Presence-Content Indifferent |
| PID-10.3 | Name of Coding System | CDCREC | Value-Profile Fixed |
| PID-10.5 | Alternate Text | Indifferent | |
| PID-10.6 | Name of Alternate Coding System | Indifferent | |
| PID-11 | Patient Address | ||
| PID-11.1 | Street Address | ||
| PID-11.1.1 | Street or Mailing Address | 9200 Wellington Trail | Presence-Content Indifferent |
| PID-11.1.2 | Street Name | ||
| PID-11.1.3 | Dwelling Number | ||
| PID-11.2 | Other Designation | Indifferent | |
| PID-11.3 | City | Bozeman | Presence-Content Indifferent |
| PID-11.4 | State or Province | MT | Presence-Content Indifferent |
| PID-11.5 | Zip or Postal Code | 59715 | Presence-Content Indifferent |
| PID-11.6 | Country | USA | Presence-Content Indifferent |
| PID-11.7 | Address Type | P | Presence-Content Indifferent |
| PID-13[1] | Phone Number - Home | ||
| PID-13[1].2 | Telecommunication Use Code | PRN | Presence-Content Indifferent |
| PID-13[1].3 | Telecommunication Equipment Type | PH | Value-Test Case Fixed |
| PID-13[1].4 | Email Address | NonPresence | |
| PID-13[1].6 | Area/City Code | 406 | Presence-Content Indifferent |
| PID-13[1].7 | Local Number | 5557896 | Presence-Content Indifferent |
| PID-13[2] | Phone Number - Home | ||
| PID-13[2].2 | Telecommunication Use Code | NET | Value-Test Case Fixed |
| PID-13[2].3 | Telecommunication Equipment Type | Internet | Value-Test Case Fixed |
| PID-13[2].4 | Email Address | Elise.Wong@isp.com | Presence-Content Indifferent |
| PID-13[2].6 | Area/City Code | NonPresence | |
| PID-13[2].7 | Local Number | NonPresence | |
| PID-22 | Ethnic Group | ||
| PID-22.1 | Identifier | 2186-5 | Presence-Content Indifferent |
| PID-22.2 | Text | Not Hispanic or Latino | Presence-Content Indifferent |
| PID-22.3 | Name of Coding System | CDCREC | Value-Profile Fixed |
| PID-22.5 | Alternate Text | Indifferent | |
| PID-22.6 | Name of Alternate Coding System | Indifferent | |
| PID-24 | Multiple Birth Indicator | N | Presence-Content Indifferent |
| PID-25 | Birth Order | 1 | Indifferent |
| PID-29 | Patient Death Date and Time | ||
| PID-29.1 | Time | Indifferent | |
| PID-30 | Patient Death Indicator | N | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1-11 | Publicity Code | ||
| PD1-11.1 | Identifier | 02 | Presence-Content Indifferent |
| PD1-11.2 | Text | Reminder/recall - any method | Presence-Content Indifferent |
| PD1-11.3 | Name of Coding System | HL70215 | Value-Profile Fixed |
| PD1-11.5 | Alternate Text | Indifferent | |
| PD1-11.6 | Name of Alternate Coding System | Indifferent | |
| PD1-12 | Protection Indicator | N | Value-Test Case Fixed |
| PD1-13 | Protection Indicator Effective Date | 20150624 | Presence-Content Indifferent |
| PD1-16 | Immunization Registry Status | A | Presence-Content Indifferent |
| PD1-17 | Immunization Registry Status Effective Date | 19830615 | Presence-Content Indifferent |
| PD1-18 | Publicity Code Effective Date | 20150624 | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | Value-Profile Fixed |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | 4422 | Presence-Content Indifferent |
| ORC-2.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-2.3 | Universal ID | Indifferent | |
| ORC-2.4 | Universal ID Type | Indifferent | |
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 13696 | Presence-Content Indifferent |
| ORC-3.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-3.3 | Universal ID | Indifferent | |
| ORC-3.4 | Universal ID Type | Indifferent | |
| ORC-10 | Entered By | ||
| ORC-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| ORC-10.2 | Family Name | ||
| ORC-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| ORC-10.2.2 | Own Surname Prefix | ||
| ORC-10.2.3 | Own Surname | ||
| ORC-10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-10.2.5 | Surname From Partner/Spouse | ||
| ORC-10.3 | Given Name | Lily | Presence-Content Indifferent |
| ORC-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| ORC-10.9 | Assigning Authority | ||
| ORC-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-10.9.2 | Universal ID | ||
| ORC-10.9.3 | Universal ID Type | ||
| ORC-10.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-10.12 | Check Digit Scheme | Indifferent | |
| ORC-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| ORC-12 | Ordering Provider | ||
| ORC-12.1 | ID Number | 654 | Presence-Content Indifferent |
| ORC-12.2 | Family Name | ||
| ORC-12.2.1 | Surname | Thomas | Presence-Content Indifferent |
| ORC-12.2.2 | Own Surname Prefix | ||
| ORC-12.2.3 | Own Surname | ||
| ORC-12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-12.2.5 | Surname From Partner/Spouse | ||
| ORC-12.3 | Given Name | Wilma | Presence-Content Indifferent |
| ORC-12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | Presence-Content Indifferent |
| ORC-12.9 | Assigning Authority | ||
| ORC-12.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-12.9.2 | Universal ID | ||
| ORC-12.9.3 | Universal ID Type | ||
| ORC-12.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-12.12 | Check Digit Scheme | Indifferent | |
| ORC-12.13 | Identifier Type Code | MD | Presence-Content Indifferent |
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | wcEHR | Presence-Content Indifferent |
| ORC-17.2 | Text | West Clinic | Presence-Content Indifferent |
| ORC-17.3 | Name of Coding System | HL70362 | Value-Profile Fixed |
| ORC-17.5 | Alternate Text | Indifferent | |
| ORC-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | Value-Profile Fixed |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | 6139 | Presence-Content Indifferent |
| ORC-2.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-2.3 | Universal ID | Indifferent | |
| ORC-2.4 | Universal ID Type | Indifferent | |
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 38760 | Presence-Content Indifferent |
| ORC-3.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-3.3 | Universal ID | Indifferent | |
| ORC-3.4 | Universal ID Type | Indifferent | |
| ORC-10 | Entered By | ||
| ORC-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| ORC-10.2 | Family Name | ||
| ORC-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| ORC-10.2.2 | Own Surname Prefix | ||
| ORC-10.2.3 | Own Surname | ||
| ORC-10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-10.2.5 | Surname From Partner/Spouse | ||
| ORC-10.3 | Given Name | Lily | Presence-Content Indifferent |
| ORC-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| ORC-10.9 | Assigning Authority | ||
| ORC-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-10.9.2 | Universal ID | ||
| ORC-10.9.3 | Universal ID Type | ||
| ORC-10.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-10.12 | Check Digit Scheme | Indifferent | |
| ORC-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| ORC-12 | Ordering Provider | ||
| ORC-12.1 | ID Number | Indifferent | |
| ORC-12.2 | Family Name | ||
| ORC-12.2.1 | Surname | Indifferent | |
| ORC-12.2.2 | Own Surname Prefix | ||
| ORC-12.2.3 | Own Surname | ||
| ORC-12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-12.2.5 | Surname From Partner/Spouse | ||
| ORC-12.3 | Given Name | Indifferent | |
| ORC-12.4 | Second and Further Given Names or Initials Thereof | Indifferent | |
| ORC-12.9 | Assigning Authority | ||
| ORC-12.9.1 | Namespace ID | Indifferent | |
| ORC-12.9.2 | Universal ID | ||
| ORC-12.9.3 | Universal ID Type | ||
| ORC-12.10 | Name Type Code | Indifferent | |
| ORC-12.12 | Check Digit Scheme | Indifferent | |
| ORC-12.13 | Identifier Type Code | Indifferent | |
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | wcEHR | Presence-Content Indifferent |
| ORC-17.2 | Text | West Clinic | Presence-Content Indifferent |
| ORC-17.3 | Name of Coding System | HL70362 | Value-Profile Fixed |
| ORC-17.5 | Alternate Text | Indifferent | |
| ORC-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | Value-Profile Fixed |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | 7600 | Presence-Content Indifferent |
| ORC-2.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-2.3 | Universal ID | Indifferent | |
| ORC-2.4 | Universal ID Type | Indifferent | |
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 35508 | Presence-Content Indifferent |
| ORC-3.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-3.3 | Universal ID | Indifferent | |
| ORC-3.4 | Universal ID Type | Indifferent | |
| ORC-10 | Entered By | ||
| ORC-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| ORC-10.2 | Family Name | ||
| ORC-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| ORC-10.2.2 | Own Surname Prefix | ||
| ORC-10.2.3 | Own Surname | ||
| ORC-10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-10.2.5 | Surname From Partner/Spouse | ||
| ORC-10.3 | Given Name | Lily | Presence-Content Indifferent |
| ORC-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| ORC-10.9 | Assigning Authority | ||
| ORC-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-10.9.2 | Universal ID | ||
| ORC-10.9.3 | Universal ID Type | ||
| ORC-10.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-10.12 | Check Digit Scheme | Indifferent | |
| ORC-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| ORC-12 | Ordering Provider | ||
| ORC-12.1 | ID Number | Indifferent | |
| ORC-12.2 | Family Name | ||
| ORC-12.2.1 | Surname | Indifferent | |
| ORC-12.2.2 | Own Surname Prefix | ||
| ORC-12.2.3 | Own Surname | ||
| ORC-12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-12.2.5 | Surname From Partner/Spouse | ||
| ORC-12.3 | Given Name | Indifferent | |
| ORC-12.4 | Second and Further Given Names or Initials Thereof | Indifferent | |
| ORC-12.9 | Assigning Authority | ||
| ORC-12.9.1 | Namespace ID | Indifferent | |
| ORC-12.9.2 | Universal ID | ||
| ORC-12.9.3 | Universal ID Type | ||
| ORC-12.10 | Name Type Code | Indifferent | |
| ORC-12.12 | Check Digit Scheme | Indifferent | |
| ORC-12.13 | Identifier Type Code | Indifferent | |
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | wcEHR | Presence-Content Indifferent |
| ORC-17.2 | Text | West Clinic | Presence-Content Indifferent |
| ORC-17.3 | Name of Coding System | HL70362 | Value-Profile Fixed |
| ORC-17.5 | Alternate Text | Indifferent | |
| ORC-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | Value-Profile Fixed |
| RXA-2 | Administration Sub-ID Counter | 1 | Value-Profile Fixed |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20150624 | Presence-Content Indifferent |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 49281-0215-88 | Value-Test Case Fixed |
| RXA-5.2 | Text | TENIVAC | Presence-Content Indifferent |
| RXA-5.3 | Name of Coding System | NDC | Value-Test Case Fixed |
| RXA-5.5 | Alternate Text | Indifferent | |
| RXA-5.6 | Name of Alternate Coding System | Indifferent | |
| RXA-6 | Administered Amount | 0.5 | Value-Test Case Fixed |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | mL | Value-Test Case Fixed |
| RXA-7.2 | Text | mL | Presence-Content Indifferent |
| RXA-7.3 | Name of Coding System | UCUM | Value-Test Case Fixed |
| RXA-7.5 | Alternate Text | Indifferent | |
| RXA-7.6 | Name of Alternate Coding System | Indifferent | |
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 00 | Value-Test Case Fixed |
| RXA-9.2 | Text | New Record | Presence-Content Indifferent |
| RXA-9.3 | Name of Coding System | NIP001 | Value-Profile Fixed |
| RXA-9.5 | Alternate Text | Indifferent | |
| RXA-9.6 | Name of Alternate Coding System | Indifferent | |
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Lily | Presence-Content Indifferent |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | L | Presence-Content Indifferent |
| RXA-10.12 | Check Digit Scheme | Indifferent | |
| RXA-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-11.4.2 | Universal ID | Indifferent | |
| RXA-11.4.3 | Universal ID Type | Indifferent | |
| RXA-15 | Substance Lot Number | 315841 | Presence-Content Indifferent |
| RXA-16 | Substance Expiration Date | ||
| RXA-16.1 | Time | 20151216 | Presence-Content Indifferent |
| RXA-17 | Substance Manufacturer Name | ||
| RXA-17.1 | Identifier | PMC | Presence-Content Indifferent |
| RXA-17.2 | Text | Sanofi Pasteur | Presence-Content Indifferent |
| RXA-17.3 | Name of Coding System | MVX | Value-Test Case Fixed |
| RXA-17.5 | Alternate Text | Indifferent | |
| RXA-17.6 | Name of Alternate Coding System | Indifferent | |
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | Indifferent | |
| RXA-18.2 | Text | Indifferent | |
| RXA-18.3 | Name of Coding System | Indifferent | |
| RXA-18.5 | Alternate Text | Indifferent | |
| RXA-18.6 | Name of Alternate Coding System | Indifferent | |
| RXA-20 | Completion Status | CP | Value-Test Case Fixed |
| RXA-21 | Action Code - RXA | A | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | Value-Profile Fixed |
| RXA-2 | Administration Sub-ID Counter | 1 | Value-Profile Fixed |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20141012 | Presence-Content Indifferent |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 88 | Value-Test Case Fixed |
| RXA-5.2 | Text | influenza, unspecified formulation | Presence-Content Indifferent |
| RXA-5.3 | Name of Coding System | CVX | Value-Test Case Fixed |
| RXA-5.5 | Alternate Text | Indifferent | |
| RXA-5.6 | Name of Alternate Coding System | Indifferent | |
| RXA-6 | Administered Amount | 999 | Value-Test Case Fixed |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | NonPresence | |
| RXA-7.2 | Text | NonPresence | |
| RXA-7.3 | Name of Coding System | NonPresence | |
| RXA-7.5 | Alternate Text | NonPresence | |
| RXA-7.6 | Name of Alternate Coding System | NonPresence | |
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 01 | Value-Test Case Fixed |
| RXA-9.2 | Text | Historical Administration | Presence-Content Indifferent |
| RXA-9.3 | Name of Coding System | NIP001 | Value-Profile Fixed |
| RXA-9.5 | Alternate Text | Indifferent | |
| RXA-9.6 | Name of Alternate Coding System | Indifferent | |
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | Indifferent | |
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Indifferent | |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Indifferent | |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | Indifferent | |
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | Indifferent | |
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | Indifferent | |
| RXA-10.12 | Check Digit Scheme | Indifferent | |
| RXA-10.13 | Identifier Type Code | Indifferent | |
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | Indifferent | |
| RXA-11.4.2 | Universal ID | Indifferent | |
| RXA-11.4.3 | Universal ID Type | Indifferent | |
| RXA-15 | Substance Lot Number | Indifferent | |
| RXA-16 | Substance Expiration Date | ||
| RXA-16.1 | Time | Indifferent | |
| RXA-17 | Substance Manufacturer Name | ||
| RXA-17.1 | Identifier | Indifferent | |
| RXA-17.2 | Text | Indifferent | |
| RXA-17.3 | Name of Coding System | Indifferent | |
| RXA-17.5 | Alternate Text | Indifferent | |
| RXA-17.6 | Name of Alternate Coding System | Indifferent | |
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | Indifferent | |
| RXA-18.2 | Text | Indifferent | |
| RXA-18.3 | Name of Coding System | Indifferent | |
| RXA-18.5 | Alternate Text | Indifferent | |
| RXA-18.6 | Name of Alternate Coding System | Indifferent | |
| RXA-20 | Completion Status | CP | Value-Test Case Fixed |
| RXA-21 | Action Code - RXA | A | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | Value-Profile Fixed |
| RXA-2 | Administration Sub-ID Counter | 1 | Value-Profile Fixed |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20131112 | Presence-Content Indifferent |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 88 | Value-Test Case Fixed |
| RXA-5.2 | Text | influenza, unspecified formulation | Presence-Content Indifferent |
| RXA-5.3 | Name of Coding System | CVX | Value-Test Case Fixed |
| RXA-5.5 | Alternate Text | Indifferent | |
| RXA-5.6 | Name of Alternate Coding System | Indifferent | |
| RXA-6 | Administered Amount | 999 | Value-Test Case Fixed |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | NonPresence | |
| RXA-7.2 | Text | NonPresence | |
| RXA-7.3 | Name of Coding System | NonPresence | |
| RXA-7.5 | Alternate Text | NonPresence | |
| RXA-7.6 | Name of Alternate Coding System | NonPresence | |
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 01 | Value-Test Case Fixed |
| RXA-9.2 | Text | Historical Administration | Presence-Content Indifferent |
| RXA-9.3 | Name of Coding System | NIP001 | Value-Profile Fixed |
| RXA-9.5 | Alternate Text | Indifferent | |
| RXA-9.6 | Name of Alternate Coding System | Indifferent | |
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | Indifferent | |
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Indifferent | |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Indifferent | |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | Indifferent | |
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | Indifferent | |
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | Indifferent | |
| RXA-10.12 | Check Digit Scheme | Indifferent | |
| RXA-10.13 | Identifier Type Code | Indifferent | |
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | Indifferent | |
| RXA-11.4.2 | Universal ID | Indifferent | |
| RXA-11.4.3 | Universal ID Type | Indifferent | |
| RXA-15 | Substance Lot Number | Indifferent | |
| RXA-16 | Substance Expiration Date | ||
| RXA-16.1 | Time | Indifferent | |
| RXA-17 | Substance Manufacturer Name | ||
| RXA-17.1 | Identifier | Indifferent | |
| RXA-17.2 | Text | Indifferent | |
| RXA-17.3 | Name of Coding System | Indifferent | |
| RXA-17.5 | Alternate Text | Indifferent | |
| RXA-17.6 | Name of Alternate Coding System | Indifferent | |
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | Indifferent | |
| RXA-18.2 | Text | Indifferent | |
| RXA-18.3 | Name of Coding System | Indifferent | |
| RXA-18.5 | Alternate Text | Indifferent | |
| RXA-18.6 | Name of Alternate Coding System | Indifferent | |
| RXA-20 | Completion Status | CP | Value-Test Case Fixed |
| RXA-21 | Action Code - RXA | A | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR-1 | Route | ||
| RXR-1.1 | Identifier | C28161 | Presence-Content Indifferent |
| RXR-1.2 | Text | Intramuscular | Presence-Content Indifferent |
| RXR-1.3 | Name of Coding System | NCIT | Value-Profile Fixed |
| RXR-1.5 | Alternate Text | Indifferent | |
| RXR-1.6 | Name of Alternate Coding System | Indifferent | |
| RXR-2 | Administration Site | ||
| RXR-2.1 | Identifier | RD | Presence-Content Indifferent |
| RXR-2.2 | Text | Right Deltoid | Presence-Content Indifferent |
| RXR-2.3 | Name of Coding System | HL70163 | Value-Profile Fixed |
| RXR-2.5 | Alternate Text | Indifferent | |
| RXR-2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 1 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30963-3 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Source | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 1 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-5.1 | Identifier | PHC70 | |
| OBX-5.2 | Text | Private | |
| OBX-5.3 | Name of Coding System | CDCPHINVS | |
| OBX-5.5 | Alternate Text | ||
| OBX-5.6 | Name of Alternate Coding System | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 2 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 64994-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Program Eligibility | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 2 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-5.1 | Identifier | V01 | |
| OBX-5.2 | Text | Not VFC Eligible | |
| OBX-5.3 | Name of Coding System | HL70064 | |
| OBX-5.5 | Alternate Text | ||
| OBX-5.6 | Name of Alternate Coding System | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | VXC40 | Value-Test Case Fixed |
| OBX-17.2 | Text | per immunization | Presence-Content Indifferent |
| OBX-17.3 | Name of Coding System | CDCPHINVS | Value-Profile Fixed |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 3 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 69764-9 | Value-Test Case Fixed |
| OBX-3.2 | Text | Document Type | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-5.1 | Identifier | 253088698300028811150224 | |
| OBX-5.2 | Text | Tetanus/Diphtheria (Td) VIS | |
| OBX-5.3 | Name of Coding System | cdcgs1vis | |
| OBX-5.5 | Alternate Text | ||
| OBX-5.6 | Name of Alternate Coding System | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 4 | Value-Profile Fixed |
| OBX-2 | Value Type | DT | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 29769-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Date Vis Presented | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | 20150624 | Presence-Content Indifferent |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Element | Data |
|---|---|
| Patient Name | Elise Wong |
| Mother's Maiden Name | |
| ID Number | 90012 |
| Date/Time of Birth | 06/15/1983 |
| Administrative Sex | Female |
| Patient Address | 9200 Wellington Trail Bozeman MT 59715 USA |
| Local Number | (406)555-7896 |
| Elise.Wong@isp.com | |
| Race | Asian |
| Ethnic Group | Not Hispanic or Latino |
| Multiple Birth Indicator | N |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 06/15/1983 |
| Publicity Code | Reminder/recall - any method |
| Publicity Code Effective Date | 06/24/2015 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 06/24/2015 |
| Element | Data |
|---|---|
| Administered Code | TENIVAC |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 315841 |
| Substance Expiration Date | 12/16/2015 |
| Substance Manufacturer Name | Sanofi Pasteur |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Right Deltoid |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Private |
| Vaccine Funding Program Eligibility | Not VFC Eligible |
| Document Type | Tetanus/Diphtheria (Td) VIS |
| Date Vis Presented | 06/24/2015 |
| Element | Data |
|---|---|
| Administered Code | influenza, unspecified formulation |
| Date/Time Start of Administration | 10/12/2014 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical Administration |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By |
| Element | Data |
|---|---|
| Administered Code | influenza, unspecified formulation |
| Date/Time Start of Administration | 11/12/2013 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical Administration |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By |
| Element | Data |
|---|---|
| Patient Name | Elise Wong |
| Mother's Maiden Name | |
| ID Number | 90012 |
| Date/Time of Birth | 06/15/1983 |
| Administrative Sex | Female |
| Patient Address | 9200 Wellington Trail Bozeman MT 59715 USA |
| Local Number | (406)555-7896 |
| Elise.Wong@isp.com | |
| Race | Asian |
| Ethnic Group | Not Hispanic or Latino |
| Multiple Birth Indicator | N |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 06/15/1983 |
| Publicity Code | Reminder/recall - any method |
| Publicity Code Effective Date | 06/24/2015 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 06/24/2015 |
| Element | Data |
|---|---|
| Administered Code | TENIVAC |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 315841 |
| Substance Expiration Date | 12/16/2015 |
| Substance Manufacturer Name | Sanofi Pasteur |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Right Deltoid |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Private |
| Vaccine Funding Program Eligibility | Not VFC Eligible |
| Document Type | Tetanus/Diphtheria (Td) VIS |
| Date Vis Presented | 06/24/2015 |
| Element | Data |
|---|---|
| Administered Code | influenza, unspecified formulation |
| Date/Time Start of Administration | 10/12/2014 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical Administration |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By |
| Element | Data |
|---|---|
| Administered Code | influenza, unspecified formulation |
| Date/Time Start of Administration | 11/12/2013 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical Administration |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By |
| Description |
|---|
| The IIS returns a positive acknowledgement message indicating that no errors were found during the course of filing the message. |
| Comments |
|---|
| No Comments |
| Pre Condition |
|---|
| A VXU message is generated by the EHR. |
| Post Condition |
|---|
| No PostCondition |
| Test Objectives |
|---|
| Evaluation Criteria |
|---|
| The acknowledgement message is consumed by the system responsible for the content of the administration message without error. |
| Notes for Testers |
|---|
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | iisApp | Presence-Content Indifferent |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | IIS | Presence-Content Indifferent |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | wcApp | Presence-Content Indifferent |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150624084727.669-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | ACK | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | ACK | Value-Profile Fixed |
| MSH-10 | Message Control ID | 74602 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z23 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | IIS | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | Indifferent | |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | Indifferent | |
| MSH-22.10 | Organization Identifier | Indifferent | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | wcEHR | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | Indifferent | |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | Indifferent | |
| MSH-23.10 | Organization Identifier | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA-1 | Acknowledgment Code | AA | Value-Test Case Fixed |
| MSA-2 | Message Control ID | 72268 | Presence-System Generated |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | iisApp | Presence-Content Indifferent |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | IIS | Presence-Content Indifferent |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | wcApp | Presence-Content Indifferent |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150624084727.669-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | ACK | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | ACK | Value-Profile Fixed |
| MSH-10 | Message Control ID | 74602 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z23 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | IIS | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | Indifferent | |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | Indifferent | |
| MSH-22.10 | Organization Identifier | Indifferent | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | wcEHR | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | Indifferent | |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | Indifferent | |
| MSH-23.10 | Organization Identifier | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA-1 | Acknowledgment Code | AA | Value-Test Case Fixed |
| MSA-2 | Message Control ID | 72268 | Presence-System Generated |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Return an Acknowledgement | |||||
|---|---|---|---|---|---|
| Test Case ID | IZ-AD-2_Admin_Adult | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement (Pass/Fail) |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which NO Error is returned in the message.
The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.
| Return an Acknowledgement |
|---|
|
The receiving HIT system being tested shall process the Z23 ACK message correctly; a positive notification indicating that the ACK message was processed correctly need not be made visible in the system. |
| Description |
|---|
| A child is seen at a clinic. A new vaccine is administered and documented but the information is not to shared by the IIS. |
| Comments |
|---|
| No Comments |
| Pre Condition |
|---|
| No PreCondition |
| Post Condition |
|---|
| No PostCondition |
| Test Objectives |
|---|
| This test case assesses the ability of the EHR to create an administration message for a child containing a new administration but an indication that the data should not be shared. Also test the ability of the EHR to support full first and middle names. |
| Evaluation Criteria |
|---|
| Notes for Testers |
|---|
| No Note |
| Description |
|---|
| An eleven and a half year old female, Katherine Mackenzie Benton, is brought to a clinic for a third and final dose of HPV vaccine. She is accompanied by her mother Kari Michelle Benton (nee Jones). A clinic staff member collects basic patient demographic information including name, date of birth and sex. The mother is given the appropriate Vaccine Information Sheet (VIS) to review. After reading it, the mother agrees that the child should receive the HPV vaccine, but she chooses not to share the data once it is incorporated into the local IIS. A clinic provider, Wilma Thomas (physician ID 654) places an order for the vaccination. While the patient is covered by insurance, the plan does not cover this vaccination and she qualifies for Vaccine For Children (VFC) supplied vaccines under the status of VFC eligible - Underinsured. An appropriate dose of HPV (CERVARIX) is selected from the clinic's stock of publically funded vaccines. A clinician, Lily Jackson (ID 7824) prepares and administers the dose to the patient and then enters the data into the EHR and transmits it to the IIS. |
| Comments |
|---|
| No Comments |
| Pre Condition |
|---|
| No PreCondition |
| Post Condition |
|---|
| No PostCondition |
| Test Objectives |
|---|
| Support for no consent given Support for a full middle name |
| Evaluation Criteria |
|---|
| Message Validation Report |
| Notes for Testers |
|---|
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | wcApp | Presence-Content Indifferent |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | iisApp | Presence-Content Indifferent |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | IIS | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150624093847.804-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | VXU | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | VXU_V04 | Value-Profile Fixed |
| MSH-10 | Message Control ID | 77732 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | ER | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | AL | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z22 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | wcEHR | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | Indifferent | |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | Indifferent | |
| MSH-22.10 | Organization Identifier | Indifferent | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | IIS | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | Indifferent | |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | Indifferent | |
| MSH-23.10 | Organization Identifier | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID-1 | Set ID - PID | 1 | Value-Profile Fixed |
| PID-3 | Patient Identifier List | ||
| PID-3.1 | ID Number | 89778 | Presence-Content Indifferent |
| PID-3.3 | Check Digit Scheme | Indifferent | |
| PID-3.4 | Assigning Authority | ||
| PID-3.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| PID-3.4.2 | Universal ID | Indifferent | |
| PID-3.4.3 | Universal ID Type | Indifferent | |
| PID-3.5 | Identifier Type Code | MR | Presence-Content Indifferent |
| PID-5 | Patient Name | ||
| PID-5.1 | Family Name | ||
| PID-5.1.1 | Surname | Benton | Presence-Content Indifferent |
| PID-5.1.2 | Own Surname Prefix | ||
| PID-5.1.3 | Own Surname | ||
| PID-5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-5.1.5 | Surname From Partner/Spouse | ||
| PID-5.2 | Given Name | Katherine | Presence Length-Content Indifferent |
| PID-5.3 | Second and Further Given Names or Initials Thereof | Mackenzie | Presence Length-Content Indifferent |
| PID-5.7 | Name Type Code | L | Presence-Content Indifferent |
| PID-6 | Mother's Maiden Name | ||
| PID-6.1 | Family Name | ||
| PID-6.1.1 | Surname | Jones | Presence-Content Indifferent |
| PID-6.1.2 | Own Surname Prefix | ||
| PID-6.1.3 | Own Surname | ||
| PID-6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-6.1.5 | Surname From Partner/Spouse | ||
| PID-6.7 | Name Type Code | M | Value-Profile Fixed |
| PID-7 | Date/Time of Birth | ||
| PID-7.1 | Time | 20031221 | Presence-Content Indifferent |
| PID-8 | Administrative Sex | F | Presence-Content Indifferent |
| PID-10 | Race | ||
| PID-10.1 | Identifier | 2106-3 | Presence-Content Indifferent |
| PID-10.2 | Text | White | Presence-Content Indifferent |
| PID-10.3 | Name of Coding System | CDCREC | Value-Profile Fixed |
| PID-10.5 | Alternate Text | Indifferent | |
| PID-10.6 | Name of Alternate Coding System | Indifferent | |
| PID-11 | Patient Address | ||
| PID-11.1 | Street Address | ||
| PID-11.1.1 | Street or Mailing Address | 89 West 21st Ave | Presence-Content Indifferent |
| PID-11.1.2 | Street Name | ||
| PID-11.1.3 | Dwelling Number | ||
| PID-11.2 | Other Designation | Indifferent | |
| PID-11.3 | City | Bozeman | Presence-Content Indifferent |
| PID-11.4 | State or Province | MT | Presence-Content Indifferent |
| PID-11.5 | Zip or Postal Code | 59715 | Presence-Content Indifferent |
| PID-11.6 | Country | USA | Presence-Content Indifferent |
| PID-11.7 | Address Type | P | Presence-Content Indifferent |
| PID-13 | Phone Number - Home | ||
| PID-13.2 | Telecommunication Use Code | PRN | Presence-Content Indifferent |
| PID-13.3 | Telecommunication Equipment Type | PH | Value-Test Case Fixed |
| PID-13.4 | Email Address | NonPresence | |
| PID-13.6 | Area/City Code | 406 | Presence-Content Indifferent |
| PID-13.7 | Local Number | 5554019 | Presence-Content Indifferent |
| PID-22 | Ethnic Group | ||
| PID-22.1 | Identifier | 2186-5 | Presence-Content Indifferent |
| PID-22.2 | Text | Not Hispanic or Latino | Presence-Content Indifferent |
| PID-22.3 | Name of Coding System | CDCREC | Value-Profile Fixed |
| PID-22.5 | Alternate Text | Indifferent | |
| PID-22.6 | Name of Alternate Coding System | Indifferent | |
| PID-24 | Multiple Birth Indicator | N | Presence-Content Indifferent |
| PID-25 | Birth Order | 1 | Indifferent |
| PID-29 | Patient Death Date and Time | ||
| PID-29.1 | Time | Indifferent | |
| PID-30 | Patient Death Indicator | N | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1-11 | Publicity Code | ||
| PD1-11.1 | Identifier | 01 | Presence-Content Indifferent |
| PD1-11.2 | Text | No reminder/recall | Presence-Content Indifferent |
| PD1-11.3 | Name of Coding System | HL70215 | Value-Profile Fixed |
| PD1-11.5 | Alternate Text | Indifferent | |
| PD1-11.6 | Name of Alternate Coding System | Indifferent | |
| PD1-12 | Protection Indicator | Y | Value-Test Case Fixed |
| PD1-13 | Protection Indicator Effective Date | 20150624 | Presence-Content Indifferent |
| PD1-16 | Immunization Registry Status | A | Presence-Content Indifferent |
| PD1-17 | Immunization Registry Status Effective Date | 20031221 | Presence-Content Indifferent |
| PD1-18 | Publicity Code Effective Date | 20150624 | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| NK1-1 | Set ID - NK1 | 1 | Value-Profile Fixed |
| NK1-2 | Name | ||
| NK1-2.1 | Family Name | ||
| NK1-2.1.1 | Surname | Benton | Presence-Content Indifferent |
| NK1-2.1.2 | Own Surname Prefix | ||
| NK1-2.1.3 | Own Surname | ||
| NK1-2.1.4 | Surname Prefix From Partner/Spouse | ||
| NK1-2.1.5 | Surname From Partner/Spouse | ||
| NK1-2.2 | Given Name | Kari | Presence-Content Indifferent |
| NK1-2.3 | Second and Further Given Names or Initials Thereof | Michelle | Presence-Content Indifferent |
| NK1-2.7 | Name Type Code | L | Presence-Content Indifferent |
| NK1-3 | Relationship | ||
| NK1-3.1 | Identifier | MTH | Presence-Content Indifferent |
| NK1-3.2 | Text | Mother | Presence-Content Indifferent |
| NK1-3.3 | Name of Coding System | HL70063 | Value-Profile Fixed |
| NK1-3.5 | Alternate Text | Indifferent | |
| NK1-3.6 | Name of Alternate Coding System | Indifferent | |
| NK1-4 | Address | ||
| NK1-4.1 | Street Address | ||
| NK1-4.1.1 | Street or Mailing Address | 89 West 21st Ave | Presence-Content Indifferent |
| NK1-4.1.2 | Street Name | ||
| NK1-4.1.3 | Dwelling Number | ||
| NK1-4.2 | Other Designation | Indifferent | |
| NK1-4.3 | City | Bozeman | Presence-Content Indifferent |
| NK1-4.4 | State or Province | MT | Presence-Content Indifferent |
| NK1-4.5 | Zip or Postal Code | 59715 | Presence-Content Indifferent |
| NK1-4.6 | Country | USA | Presence-Content Indifferent |
| NK1-4.7 | Address Type | P | Presence-Content Indifferent |
| NK1-5 | Phone Number | ||
| NK1-5.2 | Telecommunication Use Code | PRN | Presence-Content Indifferent |
| NK1-5.3 | Telecommunication Equipment Type | PH | Value-Test Case Fixed |
| NK1-5.4 | Email Address | NonPresence | |
| NK1-5.6 | Area/City Code | 406 | Presence-Content Indifferent |
| NK1-5.7 | Local Number | 5554019 | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | Value-Profile Fixed |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | 5237 | Presence-Content Indifferent |
| ORC-2.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-2.3 | Universal ID | Indifferent | |
| ORC-2.4 | Universal ID Type | Indifferent | |
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 31309 | Presence-Content Indifferent |
| ORC-3.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-3.3 | Universal ID | Indifferent | |
| ORC-3.4 | Universal ID Type | Indifferent | |
| ORC-10 | Entered By | ||
| ORC-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| ORC-10.2 | Family Name | ||
| ORC-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| ORC-10.2.2 | Own Surname Prefix | ||
| ORC-10.2.3 | Own Surname | ||
| ORC-10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-10.2.5 | Surname From Partner/Spouse | ||
| ORC-10.3 | Given Name | Lily | Presence-Content Indifferent |
| ORC-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| ORC-10.9 | Assigning Authority | ||
| ORC-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-10.9.2 | Universal ID | ||
| ORC-10.9.3 | Universal ID Type | ||
| ORC-10.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-10.12 | Check Digit Scheme | Indifferent | |
| ORC-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| ORC-12 | Ordering Provider | ||
| ORC-12.1 | ID Number | 654 | Presence-Content Indifferent |
| ORC-12.2 | Family Name | ||
| ORC-12.2.1 | Surname | Thomas | Presence-Content Indifferent |
| ORC-12.2.2 | Own Surname Prefix | ||
| ORC-12.2.3 | Own Surname | ||
| ORC-12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-12.2.5 | Surname From Partner/Spouse | ||
| ORC-12.3 | Given Name | Wilma | Presence-Content Indifferent |
| ORC-12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | Presence-Content Indifferent |
| ORC-12.9 | Assigning Authority | ||
| ORC-12.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-12.9.2 | Universal ID | ||
| ORC-12.9.3 | Universal ID Type | ||
| ORC-12.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-12.12 | Check Digit Scheme | Indifferent | |
| ORC-12.13 | Identifier Type Code | MD | Presence-Content Indifferent |
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | wcEHR | Presence-Content Indifferent |
| ORC-17.2 | Text | West Clinic | Presence-Content Indifferent |
| ORC-17.3 | Name of Coding System | HL70362 | Value-Profile Fixed |
| ORC-17.5 | Alternate Text | Indifferent | |
| ORC-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | Value-Profile Fixed |
| RXA-2 | Administration Sub-ID Counter | 1 | Value-Profile Fixed |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20150624 | Presence-Content Indifferent |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 58160-0830-05 | Value-Test Case Fixed |
| RXA-5.2 | Text | CERVARIX | Presence-Content Indifferent |
| RXA-5.3 | Name of Coding System | NDC | Value-Test Case Fixed |
| RXA-5.5 | Alternate Text | Indifferent | |
| RXA-5.6 | Name of Alternate Coding System | Indifferent | |
| RXA-6 | Administered Amount | 0.5 | Value-Test Case Fixed |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | mL | Value-Test Case Fixed |
| RXA-7.2 | Text | mL | Presence-Content Indifferent |
| RXA-7.3 | Name of Coding System | UCUM | Value-Test Case Fixed |
| RXA-7.5 | Alternate Text | Indifferent | |
| RXA-7.6 | Name of Alternate Coding System | Indifferent | |
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 00 | Value-Test Case Fixed |
| RXA-9.2 | Text | New Record | Presence-Content Indifferent |
| RXA-9.3 | Name of Coding System | NIP001 | Value-Profile Fixed |
| RXA-9.5 | Alternate Text | Indifferent | |
| RXA-9.6 | Name of Alternate Coding System | Indifferent | |
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Lily | Presence-Content Indifferent |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | L | Presence-Content Indifferent |
| RXA-10.12 | Check Digit Scheme | Indifferent | |
| RXA-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-11.4.2 | Universal ID | Indifferent | |
| RXA-11.4.3 | Universal ID Type | Indifferent | |
| RXA-15 | Substance Lot Number | 795441 | Presence-Content Indifferent |
| RXA-16 | Substance Expiration Date | ||
| RXA-16.1 | Time | 20151223 | Presence-Content Indifferent |
| RXA-17 | Substance Manufacturer Name | ||
| RXA-17.1 | Identifier | SKB | Presence-Content Indifferent |
| RXA-17.2 | Text | GlaxoSmithKline | Presence-Content Indifferent |
| RXA-17.3 | Name of Coding System | MVX | Value-Test Case Fixed |
| RXA-17.5 | Alternate Text | Indifferent | |
| RXA-17.6 | Name of Alternate Coding System | Indifferent | |
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | Indifferent | |
| RXA-18.2 | Text | Indifferent | |
| RXA-18.3 | Name of Coding System | Indifferent | |
| RXA-18.5 | Alternate Text | Indifferent | |
| RXA-18.6 | Name of Alternate Coding System | Indifferent | |
| RXA-20 | Completion Status | CP | Value-Test Case Fixed |
| RXA-21 | Action Code - RXA | A | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR-1 | Route | ||
| RXR-1.1 | Identifier | C28161 | Presence-Content Indifferent |
| RXR-1.2 | Text | Intramuscular | Presence-Content Indifferent |
| RXR-1.3 | Name of Coding System | NCIT | Value-Profile Fixed |
| RXR-1.5 | Alternate Text | Indifferent | |
| RXR-1.6 | Name of Alternate Coding System | Indifferent | |
| RXR-2 | Administration Site | ||
| RXR-2.1 | Identifier | RD | Presence-Content Indifferent |
| RXR-2.2 | Text | Right Deltoid | Presence-Content Indifferent |
| RXR-2.3 | Name of Coding System | HL70163 | Value-Profile Fixed |
| RXR-2.5 | Alternate Text | Indifferent | |
| RXR-2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 1 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30963-3 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Source | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 1 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 2 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 64994-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Program Eligibility | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 2 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | VXC40 | Value-Test Case Fixed |
| OBX-17.2 | Text | per immunization | Presence-Content Indifferent |
| OBX-17.3 | Name of Coding System | CDCPHINVS | Value-Profile Fixed |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 3 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 69764-9 | Value-Test Case Fixed |
| OBX-3.2 | Text | Document Type | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 4 | Value-Profile Fixed |
| OBX-2 | Value Type | DT | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 29769-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Date Vis Presented | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | 20150624 | Presence-Content Indifferent |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | wcApp | Presence-Content Indifferent |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | iisApp | Presence-Content Indifferent |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | IIS | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150624093847.804-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | VXU | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | VXU_V04 | Value-Profile Fixed |
| MSH-10 | Message Control ID | 77732 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | ER | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | AL | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z22 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | wcEHR | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | Indifferent | |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | Indifferent | |
| MSH-22.10 | Organization Identifier | Indifferent | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | IIS | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | Indifferent | |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | Indifferent | |
| MSH-23.10 | Organization Identifier | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID-1 | Set ID - PID | 1 | Value-Profile Fixed |
| PID-3 | Patient Identifier List | ||
| PID-3.1 | ID Number | 89778 | Presence-Content Indifferent |
| PID-3.3 | Check Digit Scheme | Indifferent | |
| PID-3.4 | Assigning Authority | ||
| PID-3.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| PID-3.4.2 | Universal ID | Indifferent | |
| PID-3.4.3 | Universal ID Type | Indifferent | |
| PID-3.5 | Identifier Type Code | MR | Presence-Content Indifferent |
| PID-5 | Patient Name | ||
| PID-5.1 | Family Name | ||
| PID-5.1.1 | Surname | Benton | Presence-Content Indifferent |
| PID-5.1.2 | Own Surname Prefix | ||
| PID-5.1.3 | Own Surname | ||
| PID-5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-5.1.5 | Surname From Partner/Spouse | ||
| PID-5.2 | Given Name | Katherine | Presence Length-Content Indifferent |
| PID-5.3 | Second and Further Given Names or Initials Thereof | Mackenzie | Presence Length-Content Indifferent |
| PID-5.7 | Name Type Code | L | Presence-Content Indifferent |
| PID-6 | Mother's Maiden Name | ||
| PID-6.1 | Family Name | ||
| PID-6.1.1 | Surname | Jones | Presence-Content Indifferent |
| PID-6.1.2 | Own Surname Prefix | ||
| PID-6.1.3 | Own Surname | ||
| PID-6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-6.1.5 | Surname From Partner/Spouse | ||
| PID-6.7 | Name Type Code | M | Value-Profile Fixed |
| PID-7 | Date/Time of Birth | ||
| PID-7.1 | Time | 20031221 | Presence-Content Indifferent |
| PID-8 | Administrative Sex | F | Presence-Content Indifferent |
| PID-10 | Race | ||
| PID-10.1 | Identifier | 2106-3 | Presence-Content Indifferent |
| PID-10.2 | Text | White | Presence-Content Indifferent |
| PID-10.3 | Name of Coding System | CDCREC | Value-Profile Fixed |
| PID-10.5 | Alternate Text | Indifferent | |
| PID-10.6 | Name of Alternate Coding System | Indifferent | |
| PID-11 | Patient Address | ||
| PID-11.1 | Street Address | ||
| PID-11.1.1 | Street or Mailing Address | 89 West 21st Ave | Presence-Content Indifferent |
| PID-11.1.2 | Street Name | ||
| PID-11.1.3 | Dwelling Number | ||
| PID-11.2 | Other Designation | Indifferent | |
| PID-11.3 | City | Bozeman | Presence-Content Indifferent |
| PID-11.4 | State or Province | MT | Presence-Content Indifferent |
| PID-11.5 | Zip or Postal Code | 59715 | Presence-Content Indifferent |
| PID-11.6 | Country | USA | Presence-Content Indifferent |
| PID-11.7 | Address Type | P | Presence-Content Indifferent |
| PID-13 | Phone Number - Home | ||
| PID-13.2 | Telecommunication Use Code | PRN | Presence-Content Indifferent |
| PID-13.3 | Telecommunication Equipment Type | PH | Value-Test Case Fixed |
| PID-13.4 | Email Address | NonPresence | |
| PID-13.6 | Area/City Code | 406 | Presence-Content Indifferent |
| PID-13.7 | Local Number | 5554019 | Presence-Content Indifferent |
| PID-22 | Ethnic Group | ||
| PID-22.1 | Identifier | 2186-5 | Presence-Content Indifferent |
| PID-22.2 | Text | Not Hispanic or Latino | Presence-Content Indifferent |
| PID-22.3 | Name of Coding System | CDCREC | Value-Profile Fixed |
| PID-22.5 | Alternate Text | Indifferent | |
| PID-22.6 | Name of Alternate Coding System | Indifferent | |
| PID-24 | Multiple Birth Indicator | N | Presence-Content Indifferent |
| PID-25 | Birth Order | 1 | Indifferent |
| PID-29 | Patient Death Date and Time | ||
| PID-29.1 | Time | Indifferent | |
| PID-30 | Patient Death Indicator | N | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1-11 | Publicity Code | ||
| PD1-11.1 | Identifier | 01 | Presence-Content Indifferent |
| PD1-11.2 | Text | No reminder/recall | Presence-Content Indifferent |
| PD1-11.3 | Name of Coding System | HL70215 | Value-Profile Fixed |
| PD1-11.5 | Alternate Text | Indifferent | |
| PD1-11.6 | Name of Alternate Coding System | Indifferent | |
| PD1-12 | Protection Indicator | Y | Value-Test Case Fixed |
| PD1-13 | Protection Indicator Effective Date | 20150624 | Presence-Content Indifferent |
| PD1-16 | Immunization Registry Status | A | Presence-Content Indifferent |
| PD1-17 | Immunization Registry Status Effective Date | 20031221 | Presence-Content Indifferent |
| PD1-18 | Publicity Code Effective Date | 20150624 | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| NK1-1 | Set ID - NK1 | 1 | Value-Profile Fixed |
| NK1-2 | Name | ||
| NK1-2.1 | Family Name | ||
| NK1-2.1.1 | Surname | Benton | Presence-Content Indifferent |
| NK1-2.1.2 | Own Surname Prefix | ||
| NK1-2.1.3 | Own Surname | ||
| NK1-2.1.4 | Surname Prefix From Partner/Spouse | ||
| NK1-2.1.5 | Surname From Partner/Spouse | ||
| NK1-2.2 | Given Name | Kari | Presence-Content Indifferent |
| NK1-2.3 | Second and Further Given Names or Initials Thereof | Michelle | Presence-Content Indifferent |
| NK1-2.7 | Name Type Code | L | Presence-Content Indifferent |
| NK1-3 | Relationship | ||
| NK1-3.1 | Identifier | MTH | Presence-Content Indifferent |
| NK1-3.2 | Text | Mother | Presence-Content Indifferent |
| NK1-3.3 | Name of Coding System | HL70063 | Value-Profile Fixed |
| NK1-3.5 | Alternate Text | Indifferent | |
| NK1-3.6 | Name of Alternate Coding System | Indifferent | |
| NK1-4 | Address | ||
| NK1-4.1 | Street Address | ||
| NK1-4.1.1 | Street or Mailing Address | 89 West 21st Ave | Presence-Content Indifferent |
| NK1-4.1.2 | Street Name | ||
| NK1-4.1.3 | Dwelling Number | ||
| NK1-4.2 | Other Designation | Indifferent | |
| NK1-4.3 | City | Bozeman | Presence-Content Indifferent |
| NK1-4.4 | State or Province | MT | Presence-Content Indifferent |
| NK1-4.5 | Zip or Postal Code | 59715 | Presence-Content Indifferent |
| NK1-4.6 | Country | USA | Presence-Content Indifferent |
| NK1-4.7 | Address Type | P | Presence-Content Indifferent |
| NK1-5 | Phone Number | ||
| NK1-5.2 | Telecommunication Use Code | PRN | Presence-Content Indifferent |
| NK1-5.3 | Telecommunication Equipment Type | PH | Value-Test Case Fixed |
| NK1-5.4 | Email Address | NonPresence | |
| NK1-5.6 | Area/City Code | 406 | Presence-Content Indifferent |
| NK1-5.7 | Local Number | 5554019 | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | Value-Profile Fixed |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | 5237 | Presence-Content Indifferent |
| ORC-2.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-2.3 | Universal ID | Indifferent | |
| ORC-2.4 | Universal ID Type | Indifferent | |
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 31309 | Presence-Content Indifferent |
| ORC-3.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-3.3 | Universal ID | Indifferent | |
| ORC-3.4 | Universal ID Type | Indifferent | |
| ORC-10 | Entered By | ||
| ORC-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| ORC-10.2 | Family Name | ||
| ORC-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| ORC-10.2.2 | Own Surname Prefix | ||
| ORC-10.2.3 | Own Surname | ||
| ORC-10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-10.2.5 | Surname From Partner/Spouse | ||
| ORC-10.3 | Given Name | Lily | Presence-Content Indifferent |
| ORC-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| ORC-10.9 | Assigning Authority | ||
| ORC-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-10.9.2 | Universal ID | ||
| ORC-10.9.3 | Universal ID Type | ||
| ORC-10.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-10.12 | Check Digit Scheme | Indifferent | |
| ORC-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| ORC-12 | Ordering Provider | ||
| ORC-12.1 | ID Number | 654 | Presence-Content Indifferent |
| ORC-12.2 | Family Name | ||
| ORC-12.2.1 | Surname | Thomas | Presence-Content Indifferent |
| ORC-12.2.2 | Own Surname Prefix | ||
| ORC-12.2.3 | Own Surname | ||
| ORC-12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-12.2.5 | Surname From Partner/Spouse | ||
| ORC-12.3 | Given Name | Wilma | Presence-Content Indifferent |
| ORC-12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | Presence-Content Indifferent |
| ORC-12.9 | Assigning Authority | ||
| ORC-12.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-12.9.2 | Universal ID | ||
| ORC-12.9.3 | Universal ID Type | ||
| ORC-12.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-12.12 | Check Digit Scheme | Indifferent | |
| ORC-12.13 | Identifier Type Code | MD | Presence-Content Indifferent |
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | wcEHR | Presence-Content Indifferent |
| ORC-17.2 | Text | West Clinic | Presence-Content Indifferent |
| ORC-17.3 | Name of Coding System | HL70362 | Value-Profile Fixed |
| ORC-17.5 | Alternate Text | Indifferent | |
| ORC-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | Value-Profile Fixed |
| RXA-2 | Administration Sub-ID Counter | 1 | Value-Profile Fixed |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20150624 | Presence-Content Indifferent |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 58160-0830-05 | Value-Test Case Fixed |
| RXA-5.2 | Text | CERVARIX | Presence-Content Indifferent |
| RXA-5.3 | Name of Coding System | NDC | Value-Test Case Fixed |
| RXA-5.5 | Alternate Text | Indifferent | |
| RXA-5.6 | Name of Alternate Coding System | Indifferent | |
| RXA-6 | Administered Amount | 0.5 | Value-Test Case Fixed |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | mL | Value-Test Case Fixed |
| RXA-7.2 | Text | mL | Presence-Content Indifferent |
| RXA-7.3 | Name of Coding System | UCUM | Value-Test Case Fixed |
| RXA-7.5 | Alternate Text | Indifferent | |
| RXA-7.6 | Name of Alternate Coding System | Indifferent | |
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 00 | Value-Test Case Fixed |
| RXA-9.2 | Text | New Record | Presence-Content Indifferent |
| RXA-9.3 | Name of Coding System | NIP001 | Value-Profile Fixed |
| RXA-9.5 | Alternate Text | Indifferent | |
| RXA-9.6 | Name of Alternate Coding System | Indifferent | |
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Lily | Presence-Content Indifferent |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | L | Presence-Content Indifferent |
| RXA-10.12 | Check Digit Scheme | Indifferent | |
| RXA-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-11.4.2 | Universal ID | Indifferent | |
| RXA-11.4.3 | Universal ID Type | Indifferent | |
| RXA-15 | Substance Lot Number | 795441 | Presence-Content Indifferent |
| RXA-16 | Substance Expiration Date | ||
| RXA-16.1 | Time | 20151223 | Presence-Content Indifferent |
| RXA-17 | Substance Manufacturer Name | ||
| RXA-17.1 | Identifier | SKB | Presence-Content Indifferent |
| RXA-17.2 | Text | GlaxoSmithKline | Presence-Content Indifferent |
| RXA-17.3 | Name of Coding System | MVX | Value-Test Case Fixed |
| RXA-17.5 | Alternate Text | Indifferent | |
| RXA-17.6 | Name of Alternate Coding System | Indifferent | |
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | Indifferent | |
| RXA-18.2 | Text | Indifferent | |
| RXA-18.3 | Name of Coding System | Indifferent | |
| RXA-18.5 | Alternate Text | Indifferent | |
| RXA-18.6 | Name of Alternate Coding System | Indifferent | |
| RXA-20 | Completion Status | CP | Value-Test Case Fixed |
| RXA-21 | Action Code - RXA | A | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR-1 | Route | ||
| RXR-1.1 | Identifier | C28161 | Presence-Content Indifferent |
| RXR-1.2 | Text | Intramuscular | Presence-Content Indifferent |
| RXR-1.3 | Name of Coding System | NCIT | Value-Profile Fixed |
| RXR-1.5 | Alternate Text | Indifferent | |
| RXR-1.6 | Name of Alternate Coding System | Indifferent | |
| RXR-2 | Administration Site | ||
| RXR-2.1 | Identifier | RD | Presence-Content Indifferent |
| RXR-2.2 | Text | Right Deltoid | Presence-Content Indifferent |
| RXR-2.3 | Name of Coding System | HL70163 | Value-Profile Fixed |
| RXR-2.5 | Alternate Text | Indifferent | |
| RXR-2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 1 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30963-3 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Source | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 1 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 2 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 64994-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Program Eligibility | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 2 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | VXC40 | Value-Test Case Fixed |
| OBX-17.2 | Text | per immunization | Presence-Content Indifferent |
| OBX-17.3 | Name of Coding System | CDCPHINVS | Value-Profile Fixed |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 3 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 69764-9 | Value-Test Case Fixed |
| OBX-3.2 | Text | Document Type | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 4 | Value-Profile Fixed |
| OBX-2 | Value Type | DT | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 29769-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Date Vis Presented | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | 20150624 | Presence-Content Indifferent |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Element | Data |
|---|---|
| Patient Name | Katherine Mackenzie Benton |
| Mother's Maiden Name | Jones |
| ID Number | 89778 |
| Date/Time of Birth | 12/21/2003 |
| Administrative Sex | Female |
| Patient Address | 89 West 21st Ave Bozeman MT 59715 USA |
| Local Number | (406)555-4019 |
| Race | White |
| Ethnic Group | Not Hispanic or Latino |
| Multiple Birth Indicator | N |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 12/21/2003 |
| Publicity Code | No reminder/recall |
| Publicity Code Effective Date | 06/24/2015 |
| Protection Indicator | Yes |
| Protection Indicator Effective Date | 06/24/2015 |
| Element | Data |
|---|---|
| Name | Kari Michelle Benton |
| Relationship | Mother |
| Address | 89 West 21st Ave Bozeman MT 59715 USA |
| Phone Number | (406)555-4019 |
| Element | Data |
|---|---|
| Administered Code | CERVARIX |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 795441 |
| Substance Expiration Date | 12/23/2015 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Right Deltoid |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Public |
| Vaccine Funding Program Eligibility | VFC Eligible - Underinsured |
| Document Type | Human papillomavirus Vaccine (Cervarix) VIS |
| Date Vis Presented | 06/24/2015 |
| Element | Data |
|---|---|
| Patient Name | Katherine Mackenzie Benton |
| Mother's Maiden Name | Jones |
| ID Number | 89778 |
| Date/Time of Birth | 12/21/2003 |
| Administrative Sex | Female |
| Patient Address | 89 West 21st Ave Bozeman MT 59715 USA |
| Local Number | (406)555-4019 |
| Race | White |
| Ethnic Group | Not Hispanic or Latino |
| Multiple Birth Indicator | N |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 12/21/2003 |
| Publicity Code | No reminder/recall |
| Publicity Code Effective Date | 06/24/2015 |
| Protection Indicator | Yes |
| Protection Indicator Effective Date | 06/24/2015 |
| Element | Data |
|---|---|
| Name | Kari Michelle Benton |
| Relationship | Mother |
| Address | 89 West 21st Ave Bozeman MT 59715 USA |
| Phone Number | (406)555-4019 |
| Element | Data |
|---|---|
| Administered Code | CERVARIX |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 795441 |
| Substance Expiration Date | 12/23/2015 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Right Deltoid |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Public |
| Vaccine Funding Program Eligibility | VFC Eligible - Underinsured |
| Document Type | Human papillomavirus Vaccine (Cervarix) VIS |
| Date Vis Presented | 06/24/2015 |
| Description |
|---|
| The IIS returns a positive acknowledgement message indicating that no errors were found during the course of filing the message. |
| Comments |
|---|
| No Comments |
| Pre Condition |
|---|
| A VXU message is generated by the EHR. |
| Post Condition |
|---|
| No PostCondition |
| Test Objectives |
|---|
| Evaluation Criteria |
|---|
| The acknowledgement message is consumed by the system responsible for the content of the administration message without error. |
| Notes for Testers |
|---|
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | iisApp | Presence-Content Indifferent |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | IIS | Presence-Content Indifferent |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | wcApp | Presence-Content Indifferent |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150624093847.806-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | ACK | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | ACK | Value-Profile Fixed |
| MSH-10 | Message Control ID | 65657 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z23 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | IIS | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | Indifferent | |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | Indifferent | |
| MSH-22.10 | Organization Identifier | Indifferent | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | wcEHR | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | Indifferent | |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | Indifferent | |
| MSH-23.10 | Organization Identifier | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA-1 | Acknowledgment Code | AA | Value-Test Case Fixed |
| MSA-2 | Message Control ID | 77732 | Presence-System Generated |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | iisApp | Presence-Content Indifferent |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | IIS | Presence-Content Indifferent |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | wcApp | Presence-Content Indifferent |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150624093847.806-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | ACK | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | ACK | Value-Profile Fixed |
| MSH-10 | Message Control ID | 65657 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z23 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | IIS | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | Indifferent | |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | Indifferent | |
| MSH-22.10 | Organization Identifier | Indifferent | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | wcEHR | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | Indifferent | |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | Indifferent | |
| MSH-23.10 | Organization Identifier | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA-1 | Acknowledgment Code | AA | Value-Test Case Fixed |
| MSA-2 | Message Control ID | 77732 | Presence-System Generated |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Return an Acknowledgement | |||||
|---|---|---|---|---|---|
| Test Case ID | IZ-AD-3_No_Consent | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement (Pass/Fail) |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which NO Error is returned in the message.
The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.
| Return an Acknowledgement |
|---|
|
The receiving HIT system being tested shall process the Z23 ACK message correctly; a positive notification indicating that the ACK message was processed correctly need not be made visible in the system. |
| Description |
|---|
| A child is seen at a clinic. A previously documented vaccination is deleted due to user error. |
| Comments |
|---|
| No Comments |
| Pre Condition |
|---|
| The IZ-AD-3_No_Consent test case has been successfully completed. |
| Post Condition |
|---|
| No PostCondition |
| Test Objectives |
|---|
| This test case assesses the ability of the EHR to create a delete message for a previously sent administration. |
| Evaluation Criteria |
|---|
| Notes for Testers |
|---|
| No Note |
| Description |
|---|
| After administering an HPV vaccination to the eleven and a half year old female Katherine Benton the clinician, Lily Jackson (ID 7824) realizes that the vaccination was documented on the incorrect patient chart. She deletes the vaccination from the patient chart and transmits the change to the IIS. |
| Comments |
|---|
| No Comments |
| Pre Condition |
|---|
| The IZ-AD-3.1_Send_V04_Z22 test step has been successfully completed. |
| Post Condition |
|---|
| No PostCondition |
| Test Objectives |
|---|
| Support for sending delete requests. |
| Evaluation Criteria |
|---|
| Message Validation Report |
| Notes for Testers |
|---|
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | wcApp | Presence-Content Indifferent |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | iisApp | Presence-Content Indifferent |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | IIS | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150624093847.804-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | VXU | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | VXU_V04 | Value-Profile Fixed |
| MSH-10 | Message Control ID | 71892 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | ER | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | AL | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z22 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | wcEHR | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | Indifferent | |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | Indifferent | |
| MSH-22.10 | Organization Identifier | Indifferent | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | IIS | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | Indifferent | |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | Indifferent | |
| MSH-23.10 | Organization Identifier | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID-1 | Set ID - PID | 1 | Value-Profile Fixed |
| PID-3 | Patient Identifier List | ||
| PID-3.1 | ID Number | 89778 | Presence-Content Indifferent |
| PID-3.3 | Check Digit Scheme | Indifferent | |
| PID-3.4 | Assigning Authority | ||
| PID-3.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| PID-3.4.2 | Universal ID | Indifferent | |
| PID-3.4.3 | Universal ID Type | Indifferent | |
| PID-3.5 | Identifier Type Code | MR | Presence-Content Indifferent |
| PID-5 | Patient Name | ||
| PID-5.1 | Family Name | ||
| PID-5.1.1 | Surname | Benton | Presence-Content Indifferent |
| PID-5.1.2 | Own Surname Prefix | ||
| PID-5.1.3 | Own Surname | ||
| PID-5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-5.1.5 | Surname From Partner/Spouse | ||
| PID-5.2 | Given Name | Katherine | Presence Length-Content Indifferent |
| PID-5.3 | Second and Further Given Names or Initials Thereof | Mackenzie | Presence Length-Content Indifferent |
| PID-5.7 | Name Type Code | L | Presence-Content Indifferent |
| PID-6 | Mother's Maiden Name | ||
| PID-6.1 | Family Name | ||
| PID-6.1.1 | Surname | Jones | Presence-Content Indifferent |
| PID-6.1.2 | Own Surname Prefix | ||
| PID-6.1.3 | Own Surname | ||
| PID-6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-6.1.5 | Surname From Partner/Spouse | ||
| PID-6.7 | Name Type Code | M | Value-Profile Fixed |
| PID-7 | Date/Time of Birth | ||
| PID-7.1 | Time | 20031221 | Presence-Content Indifferent |
| PID-8 | Administrative Sex | F | Presence-Content Indifferent |
| PID-10 | Race | ||
| PID-10.1 | Identifier | 2106-3 | Presence-Content Indifferent |
| PID-10.2 | Text | White | Presence-Content Indifferent |
| PID-10.3 | Name of Coding System | CDCREC | Value-Profile Fixed |
| PID-10.5 | Alternate Text | Indifferent | |
| PID-10.6 | Name of Alternate Coding System | Indifferent | |
| PID-11 | Patient Address | ||
| PID-11.1 | Street Address | ||
| PID-11.1.1 | Street or Mailing Address | 89 West 21st Ave | Presence-Content Indifferent |
| PID-11.1.2 | Street Name | ||
| PID-11.1.3 | Dwelling Number | ||
| PID-11.2 | Other Designation | Indifferent | |
| PID-11.3 | City | Bozeman | Presence-Content Indifferent |
| PID-11.4 | State or Province | MT | Presence-Content Indifferent |
| PID-11.5 | Zip or Postal Code | 59715 | Presence-Content Indifferent |
| PID-11.6 | Country | USA | Presence-Content Indifferent |
| PID-11.7 | Address Type | P | Presence-Content Indifferent |
| PID-13 | Phone Number - Home | ||
| PID-13.2 | Telecommunication Use Code | PRN | Presence-Content Indifferent |
| PID-13.3 | Telecommunication Equipment Type | PH | Value-Test Case Fixed |
| PID-13.4 | Email Address | NonPresence | |
| PID-13.6 | Area/City Code | 406 | Presence-Content Indifferent |
| PID-13.7 | Local Number | 5554019 | Presence-Content Indifferent |
| PID-22 | Ethnic Group | ||
| PID-22.1 | Identifier | 2186-5 | Presence-Content Indifferent |
| PID-22.2 | Text | Not Hispanic or Latino | Presence-Content Indifferent |
| PID-22.3 | Name of Coding System | CDCREC | Value-Profile Fixed |
| PID-22.5 | Alternate Text | Indifferent | |
| PID-22.6 | Name of Alternate Coding System | Indifferent | |
| PID-24 | Multiple Birth Indicator | N | Presence-Content Indifferent |
| PID-25 | Birth Order | 1 | Indifferent |
| PID-29 | Patient Death Date and Time | ||
| PID-29.1 | Time | Indifferent | |
| PID-30 | Patient Death Indicator | N | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1-11 | Publicity Code | ||
| PD1-11.1 | Identifier | 01 | Presence-Content Indifferent |
| PD1-11.2 | Text | No reminder/recall | Presence-Content Indifferent |
| PD1-11.3 | Name of Coding System | HL70215 | Value-Profile Fixed |
| PD1-11.5 | Alternate Text | Indifferent | |
| PD1-11.6 | Name of Alternate Coding System | Indifferent | |
| PD1-12 | Protection Indicator | Y | Value-Test Case Fixed |
| PD1-13 | Protection Indicator Effective Date | 20150624 | Presence-Content Indifferent |
| PD1-16 | Immunization Registry Status | A | Presence-Content Indifferent |
| PD1-17 | Immunization Registry Status Effective Date | 20031221 | Presence-Content Indifferent |
| PD1-18 | Publicity Code Effective Date | 20150624 | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| NK1-1 | Set ID - NK1 | 1 | Value-Profile Fixed |
| NK1-2 | Name | ||
| NK1-2.1 | Family Name | ||
| NK1-2.1.1 | Surname | Benton | Presence-Content Indifferent |
| NK1-2.1.2 | Own Surname Prefix | ||
| NK1-2.1.3 | Own Surname | ||
| NK1-2.1.4 | Surname Prefix From Partner/Spouse | ||
| NK1-2.1.5 | Surname From Partner/Spouse | ||
| NK1-2.2 | Given Name | Kari | Presence-Content Indifferent |
| NK1-2.3 | Second and Further Given Names or Initials Thereof | Michelle | Presence-Content Indifferent |
| NK1-2.7 | Name Type Code | L | Presence-Content Indifferent |
| NK1-3 | Relationship | ||
| NK1-3.1 | Identifier | MTH | Presence-Content Indifferent |
| NK1-3.2 | Text | Mother | Presence-Content Indifferent |
| NK1-3.3 | Name of Coding System | HL70063 | Value-Profile Fixed |
| NK1-3.5 | Alternate Text | Indifferent | |
| NK1-3.6 | Name of Alternate Coding System | Indifferent | |
| NK1-4 | Address | ||
| NK1-4.1 | Street Address | ||
| NK1-4.1.1 | Street or Mailing Address | 89 West 21st Ave | Presence-Content Indifferent |
| NK1-4.1.2 | Street Name | ||
| NK1-4.1.3 | Dwelling Number | ||
| NK1-4.2 | Other Designation | Indifferent | |
| NK1-4.3 | City | Bozeman | Presence-Content Indifferent |
| NK1-4.4 | State or Province | MT | Presence-Content Indifferent |
| NK1-4.5 | Zip or Postal Code | 59715 | Presence-Content Indifferent |
| NK1-4.6 | Country | USA | Presence-Content Indifferent |
| NK1-4.7 | Address Type | P | Presence-Content Indifferent |
| NK1-5 | Phone Number | ||
| NK1-5.2 | Telecommunication Use Code | PRN | Presence-Content Indifferent |
| NK1-5.3 | Telecommunication Equipment Type | PH | Value-Test Case Fixed |
| NK1-5.4 | Email Address | NonPresence | |
| NK1-5.6 | Area/City Code | 406 | Presence-Content Indifferent |
| NK1-5.7 | Local Number | 5554019 | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | Value-Profile Fixed |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | 5237 | Presence-Content Indifferent |
| ORC-2.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-2.3 | Universal ID | Indifferent | |
| ORC-2.4 | Universal ID Type | Indifferent | |
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 31309 | Presence-Content Indifferent |
| ORC-3.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-3.3 | Universal ID | Indifferent | |
| ORC-3.4 | Universal ID Type | Indifferent | |
| ORC-10 | Entered By | ||
| ORC-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| ORC-10.2 | Family Name | ||
| ORC-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| ORC-10.2.2 | Own Surname Prefix | ||
| ORC-10.2.3 | Own Surname | ||
| ORC-10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-10.2.5 | Surname From Partner/Spouse | ||
| ORC-10.3 | Given Name | Lily | Presence-Content Indifferent |
| ORC-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| ORC-10.9 | Assigning Authority | ||
| ORC-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-10.9.2 | Universal ID | ||
| ORC-10.9.3 | Universal ID Type | ||
| ORC-10.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-10.12 | Check Digit Scheme | Indifferent | |
| ORC-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| ORC-12 | Ordering Provider | ||
| ORC-12.1 | ID Number | 654 | Presence-Content Indifferent |
| ORC-12.2 | Family Name | ||
| ORC-12.2.1 | Surname | Thomas | Presence-Content Indifferent |
| ORC-12.2.2 | Own Surname Prefix | ||
| ORC-12.2.3 | Own Surname | ||
| ORC-12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-12.2.5 | Surname From Partner/Spouse | ||
| ORC-12.3 | Given Name | Wilma | Presence-Content Indifferent |
| ORC-12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | Presence-Content Indifferent |
| ORC-12.9 | Assigning Authority | ||
| ORC-12.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-12.9.2 | Universal ID | ||
| ORC-12.9.3 | Universal ID Type | ||
| ORC-12.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-12.12 | Check Digit Scheme | Indifferent | |
| ORC-12.13 | Identifier Type Code | MD | Presence-Content Indifferent |
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | wcEHR | Presence-Content Indifferent |
| ORC-17.2 | Text | West Clinic | Presence-Content Indifferent |
| ORC-17.3 | Name of Coding System | HL70362 | Value-Profile Fixed |
| ORC-17.5 | Alternate Text | Indifferent | |
| ORC-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | Value-Profile Fixed |
| RXA-2 | Administration Sub-ID Counter | 1 | Value-Profile Fixed |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20150624 | Presence-Content Indifferent |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 58160-0830-05 | Value-Test Case Fixed |
| RXA-5.2 | Text | CERVARIX | Presence-Content Indifferent |
| RXA-5.3 | Name of Coding System | NDC | Value-Test Case Fixed |
| RXA-5.5 | Alternate Text | Indifferent | |
| RXA-5.6 | Name of Alternate Coding System | Indifferent | |
| RXA-6 | Administered Amount | 0.5 | Value-Test Case Fixed |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | mL | Value-Test Case Fixed |
| RXA-7.2 | Text | mL | Presence-Content Indifferent |
| RXA-7.3 | Name of Coding System | UCUM | Value-Test Case Fixed |
| RXA-7.5 | Alternate Text | Indifferent | |
| RXA-7.6 | Name of Alternate Coding System | Indifferent | |
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 00 | Value-Test Case Fixed |
| RXA-9.2 | Text | New Record | Presence-Content Indifferent |
| RXA-9.3 | Name of Coding System | NIP001 | Value-Profile Fixed |
| RXA-9.5 | Alternate Text | Indifferent | |
| RXA-9.6 | Name of Alternate Coding System | Indifferent | |
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Lily | Presence-Content Indifferent |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | L | Presence-Content Indifferent |
| RXA-10.12 | Check Digit Scheme | Indifferent | |
| RXA-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-11.4.2 | Universal ID | Indifferent | |
| RXA-11.4.3 | Universal ID Type | Indifferent | |
| RXA-15 | Substance Lot Number | 795441 | Presence-Content Indifferent |
| RXA-16 | Substance Expiration Date | ||
| RXA-16.1 | Time | 20151223 | Presence-Content Indifferent |
| RXA-17 | Substance Manufacturer Name | ||
| RXA-17.1 | Identifier | SKB | Presence-Content Indifferent |
| RXA-17.2 | Text | GlaxoSmithKline | Presence-Content Indifferent |
| RXA-17.3 | Name of Coding System | MVX | Value-Test Case Fixed |
| RXA-17.5 | Alternate Text | Indifferent | |
| RXA-17.6 | Name of Alternate Coding System | Indifferent | |
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | Indifferent | |
| RXA-18.2 | Text | Indifferent | |
| RXA-18.3 | Name of Coding System | Indifferent | |
| RXA-18.5 | Alternate Text | Indifferent | |
| RXA-18.6 | Name of Alternate Coding System | Indifferent | |
| RXA-20 | Completion Status | CP | Value-Test Case Fixed |
| RXA-21 | Action Code - RXA | D | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR-1 | Route | ||
| RXR-1.1 | Identifier | C28161 | Presence-Content Indifferent |
| RXR-1.2 | Text | Intramuscular | Presence-Content Indifferent |
| RXR-1.3 | Name of Coding System | NCIT | Value-Profile Fixed |
| RXR-1.5 | Alternate Text | Indifferent | |
| RXR-1.6 | Name of Alternate Coding System | Indifferent | |
| RXR-2 | Administration Site | ||
| RXR-2.1 | Identifier | RD | Presence-Content Indifferent |
| RXR-2.2 | Text | Right Deltoid | Presence-Content Indifferent |
| RXR-2.3 | Name of Coding System | HL70163 | Value-Profile Fixed |
| RXR-2.5 | Alternate Text | Indifferent | |
| RXR-2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 1 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30963-3 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Source | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 1 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 2 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 64994-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Program Eligibility | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 2 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | VXC40 | Value-Test Case Fixed |
| OBX-17.2 | Text | per immunization | Presence-Content Indifferent |
| OBX-17.3 | Name of Coding System | CDCPHINVS | Value-Profile Fixed |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 3 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 69764-9 | Value-Test Case Fixed |
| OBX-3.2 | Text | Document Type | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 4 | Value-Profile Fixed |
| OBX-2 | Value Type | DT | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 29769-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Date Vis Presented | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | 20150624 | Presence-Content Indifferent |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | wcApp | Presence-Content Indifferent |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | iisApp | Presence-Content Indifferent |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | IIS | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150624093847.804-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | VXU | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | VXU_V04 | Value-Profile Fixed |
| MSH-10 | Message Control ID | 71892 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | ER | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | AL | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z22 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | wcEHR | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | Indifferent | |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | Indifferent | |
| MSH-22.10 | Organization Identifier | Indifferent | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | IIS | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | Indifferent | |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | Indifferent | |
| MSH-23.10 | Organization Identifier | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID-1 | Set ID - PID | 1 | Value-Profile Fixed |
| PID-3 | Patient Identifier List | ||
| PID-3.1 | ID Number | 89778 | Presence-Content Indifferent |
| PID-3.3 | Check Digit Scheme | Indifferent | |
| PID-3.4 | Assigning Authority | ||
| PID-3.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| PID-3.4.2 | Universal ID | Indifferent | |
| PID-3.4.3 | Universal ID Type | Indifferent | |
| PID-3.5 | Identifier Type Code | MR | Presence-Content Indifferent |
| PID-5 | Patient Name | ||
| PID-5.1 | Family Name | ||
| PID-5.1.1 | Surname | Benton | Presence-Content Indifferent |
| PID-5.1.2 | Own Surname Prefix | ||
| PID-5.1.3 | Own Surname | ||
| PID-5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-5.1.5 | Surname From Partner/Spouse | ||
| PID-5.2 | Given Name | Katherine | Presence Length-Content Indifferent |
| PID-5.3 | Second and Further Given Names or Initials Thereof | Mackenzie | Presence Length-Content Indifferent |
| PID-5.7 | Name Type Code | L | Presence-Content Indifferent |
| PID-6 | Mother's Maiden Name | ||
| PID-6.1 | Family Name | ||
| PID-6.1.1 | Surname | Jones | Presence-Content Indifferent |
| PID-6.1.2 | Own Surname Prefix | ||
| PID-6.1.3 | Own Surname | ||
| PID-6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-6.1.5 | Surname From Partner/Spouse | ||
| PID-6.7 | Name Type Code | M | Value-Profile Fixed |
| PID-7 | Date/Time of Birth | ||
| PID-7.1 | Time | 20031221 | Presence-Content Indifferent |
| PID-8 | Administrative Sex | F | Presence-Content Indifferent |
| PID-10 | Race | ||
| PID-10.1 | Identifier | 2106-3 | Presence-Content Indifferent |
| PID-10.2 | Text | White | Presence-Content Indifferent |
| PID-10.3 | Name of Coding System | CDCREC | Value-Profile Fixed |
| PID-10.5 | Alternate Text | Indifferent | |
| PID-10.6 | Name of Alternate Coding System | Indifferent | |
| PID-11 | Patient Address | ||
| PID-11.1 | Street Address | ||
| PID-11.1.1 | Street or Mailing Address | 89 West 21st Ave | Presence-Content Indifferent |
| PID-11.1.2 | Street Name | ||
| PID-11.1.3 | Dwelling Number | ||
| PID-11.2 | Other Designation | Indifferent | |
| PID-11.3 | City | Bozeman | Presence-Content Indifferent |
| PID-11.4 | State or Province | MT | Presence-Content Indifferent |
| PID-11.5 | Zip or Postal Code | 59715 | Presence-Content Indifferent |
| PID-11.6 | Country | USA | Presence-Content Indifferent |
| PID-11.7 | Address Type | P | Presence-Content Indifferent |
| PID-13 | Phone Number - Home | ||
| PID-13.2 | Telecommunication Use Code | PRN | Presence-Content Indifferent |
| PID-13.3 | Telecommunication Equipment Type | PH | Value-Test Case Fixed |
| PID-13.4 | Email Address | NonPresence | |
| PID-13.6 | Area/City Code | 406 | Presence-Content Indifferent |
| PID-13.7 | Local Number | 5554019 | Presence-Content Indifferent |
| PID-22 | Ethnic Group | ||
| PID-22.1 | Identifier | 2186-5 | Presence-Content Indifferent |
| PID-22.2 | Text | Not Hispanic or Latino | Presence-Content Indifferent |
| PID-22.3 | Name of Coding System | CDCREC | Value-Profile Fixed |
| PID-22.5 | Alternate Text | Indifferent | |
| PID-22.6 | Name of Alternate Coding System | Indifferent | |
| PID-24 | Multiple Birth Indicator | N | Presence-Content Indifferent |
| PID-25 | Birth Order | 1 | Indifferent |
| PID-29 | Patient Death Date and Time | ||
| PID-29.1 | Time | Indifferent | |
| PID-30 | Patient Death Indicator | N | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1-11 | Publicity Code | ||
| PD1-11.1 | Identifier | 01 | Presence-Content Indifferent |
| PD1-11.2 | Text | No reminder/recall | Presence-Content Indifferent |
| PD1-11.3 | Name of Coding System | HL70215 | Value-Profile Fixed |
| PD1-11.5 | Alternate Text | Indifferent | |
| PD1-11.6 | Name of Alternate Coding System | Indifferent | |
| PD1-12 | Protection Indicator | Y | Value-Test Case Fixed |
| PD1-13 | Protection Indicator Effective Date | 20150624 | Presence-Content Indifferent |
| PD1-16 | Immunization Registry Status | A | Presence-Content Indifferent |
| PD1-17 | Immunization Registry Status Effective Date | 20031221 | Presence-Content Indifferent |
| PD1-18 | Publicity Code Effective Date | 20150624 | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| NK1-1 | Set ID - NK1 | 1 | Value-Profile Fixed |
| NK1-2 | Name | ||
| NK1-2.1 | Family Name | ||
| NK1-2.1.1 | Surname | Benton | Presence-Content Indifferent |
| NK1-2.1.2 | Own Surname Prefix | ||
| NK1-2.1.3 | Own Surname | ||
| NK1-2.1.4 | Surname Prefix From Partner/Spouse | ||
| NK1-2.1.5 | Surname From Partner/Spouse | ||
| NK1-2.2 | Given Name | Kari | Presence-Content Indifferent |
| NK1-2.3 | Second and Further Given Names or Initials Thereof | Michelle | Presence-Content Indifferent |
| NK1-2.7 | Name Type Code | L | Presence-Content Indifferent |
| NK1-3 | Relationship | ||
| NK1-3.1 | Identifier | MTH | Presence-Content Indifferent |
| NK1-3.2 | Text | Mother | Presence-Content Indifferent |
| NK1-3.3 | Name of Coding System | HL70063 | Value-Profile Fixed |
| NK1-3.5 | Alternate Text | Indifferent | |
| NK1-3.6 | Name of Alternate Coding System | Indifferent | |
| NK1-4 | Address | ||
| NK1-4.1 | Street Address | ||
| NK1-4.1.1 | Street or Mailing Address | 89 West 21st Ave | Presence-Content Indifferent |
| NK1-4.1.2 | Street Name | ||
| NK1-4.1.3 | Dwelling Number | ||
| NK1-4.2 | Other Designation | Indifferent | |
| NK1-4.3 | City | Bozeman | Presence-Content Indifferent |
| NK1-4.4 | State or Province | MT | Presence-Content Indifferent |
| NK1-4.5 | Zip or Postal Code | 59715 | Presence-Content Indifferent |
| NK1-4.6 | Country | USA | Presence-Content Indifferent |
| NK1-4.7 | Address Type | P | Presence-Content Indifferent |
| NK1-5 | Phone Number | ||
| NK1-5.2 | Telecommunication Use Code | PRN | Presence-Content Indifferent |
| NK1-5.3 | Telecommunication Equipment Type | PH | Value-Test Case Fixed |
| NK1-5.4 | Email Address | NonPresence | |
| NK1-5.6 | Area/City Code | 406 | Presence-Content Indifferent |
| NK1-5.7 | Local Number | 5554019 | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | Value-Profile Fixed |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | 5237 | Presence-Content Indifferent |
| ORC-2.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-2.3 | Universal ID | Indifferent | |
| ORC-2.4 | Universal ID Type | Indifferent | |
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 31309 | Presence-Content Indifferent |
| ORC-3.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-3.3 | Universal ID | Indifferent | |
| ORC-3.4 | Universal ID Type | Indifferent | |
| ORC-10 | Entered By | ||
| ORC-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| ORC-10.2 | Family Name | ||
| ORC-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| ORC-10.2.2 | Own Surname Prefix | ||
| ORC-10.2.3 | Own Surname | ||
| ORC-10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-10.2.5 | Surname From Partner/Spouse | ||
| ORC-10.3 | Given Name | Lily | Presence-Content Indifferent |
| ORC-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| ORC-10.9 | Assigning Authority | ||
| ORC-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-10.9.2 | Universal ID | ||
| ORC-10.9.3 | Universal ID Type | ||
| ORC-10.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-10.12 | Check Digit Scheme | Indifferent | |
| ORC-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| ORC-12 | Ordering Provider | ||
| ORC-12.1 | ID Number | 654 | Presence-Content Indifferent |
| ORC-12.2 | Family Name | ||
| ORC-12.2.1 | Surname | Thomas | Presence-Content Indifferent |
| ORC-12.2.2 | Own Surname Prefix | ||
| ORC-12.2.3 | Own Surname | ||
| ORC-12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-12.2.5 | Surname From Partner/Spouse | ||
| ORC-12.3 | Given Name | Wilma | Presence-Content Indifferent |
| ORC-12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | Presence-Content Indifferent |
| ORC-12.9 | Assigning Authority | ||
| ORC-12.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-12.9.2 | Universal ID | ||
| ORC-12.9.3 | Universal ID Type | ||
| ORC-12.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-12.12 | Check Digit Scheme | Indifferent | |
| ORC-12.13 | Identifier Type Code | MD | Presence-Content Indifferent |
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | wcEHR | Presence-Content Indifferent |
| ORC-17.2 | Text | West Clinic | Presence-Content Indifferent |
| ORC-17.3 | Name of Coding System | HL70362 | Value-Profile Fixed |
| ORC-17.5 | Alternate Text | Indifferent | |
| ORC-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | Value-Profile Fixed |
| RXA-2 | Administration Sub-ID Counter | 1 | Value-Profile Fixed |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20150624 | Presence-Content Indifferent |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 58160-0830-05 | Value-Test Case Fixed |
| RXA-5.2 | Text | CERVARIX | Presence-Content Indifferent |
| RXA-5.3 | Name of Coding System | NDC | Value-Test Case Fixed |
| RXA-5.5 | Alternate Text | Indifferent | |
| RXA-5.6 | Name of Alternate Coding System | Indifferent | |
| RXA-6 | Administered Amount | 0.5 | Value-Test Case Fixed |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | mL | Value-Test Case Fixed |
| RXA-7.2 | Text | mL | Presence-Content Indifferent |
| RXA-7.3 | Name of Coding System | UCUM | Value-Test Case Fixed |
| RXA-7.5 | Alternate Text | Indifferent | |
| RXA-7.6 | Name of Alternate Coding System | Indifferent | |
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 00 | Value-Test Case Fixed |
| RXA-9.2 | Text | New Record | Presence-Content Indifferent |
| RXA-9.3 | Name of Coding System | NIP001 | Value-Profile Fixed |
| RXA-9.5 | Alternate Text | Indifferent | |
| RXA-9.6 | Name of Alternate Coding System | Indifferent | |
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Lily | Presence-Content Indifferent |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | L | Presence-Content Indifferent |
| RXA-10.12 | Check Digit Scheme | Indifferent | |
| RXA-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-11.4.2 | Universal ID | Indifferent | |
| RXA-11.4.3 | Universal ID Type | Indifferent | |
| RXA-15 | Substance Lot Number | 795441 | Presence-Content Indifferent |
| RXA-16 | Substance Expiration Date | ||
| RXA-16.1 | Time | 20151223 | Presence-Content Indifferent |
| RXA-17 | Substance Manufacturer Name | ||
| RXA-17.1 | Identifier | SKB | Presence-Content Indifferent |
| RXA-17.2 | Text | GlaxoSmithKline | Presence-Content Indifferent |
| RXA-17.3 | Name of Coding System | MVX | Value-Test Case Fixed |
| RXA-17.5 | Alternate Text | Indifferent | |
| RXA-17.6 | Name of Alternate Coding System | Indifferent | |
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | Indifferent | |
| RXA-18.2 | Text | Indifferent | |
| RXA-18.3 | Name of Coding System | Indifferent | |
| RXA-18.5 | Alternate Text | Indifferent | |
| RXA-18.6 | Name of Alternate Coding System | Indifferent | |
| RXA-20 | Completion Status | CP | Value-Test Case Fixed |
| RXA-21 | Action Code - RXA | D | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR-1 | Route | ||
| RXR-1.1 | Identifier | C28161 | Presence-Content Indifferent |
| RXR-1.2 | Text | Intramuscular | Presence-Content Indifferent |
| RXR-1.3 | Name of Coding System | NCIT | Value-Profile Fixed |
| RXR-1.5 | Alternate Text | Indifferent | |
| RXR-1.6 | Name of Alternate Coding System | Indifferent | |
| RXR-2 | Administration Site | ||
| RXR-2.1 | Identifier | RD | Presence-Content Indifferent |
| RXR-2.2 | Text | Right Deltoid | Presence-Content Indifferent |
| RXR-2.3 | Name of Coding System | HL70163 | Value-Profile Fixed |
| RXR-2.5 | Alternate Text | Indifferent | |
| RXR-2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 1 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30963-3 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Source | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 1 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 2 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 64994-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Program Eligibility | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 2 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | VXC40 | Value-Test Case Fixed |
| OBX-17.2 | Text | per immunization | Presence-Content Indifferent |
| OBX-17.3 | Name of Coding System | CDCPHINVS | Value-Profile Fixed |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 3 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 69764-9 | Value-Test Case Fixed |
| OBX-3.2 | Text | Document Type | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 4 | Value-Profile Fixed |
| OBX-2 | Value Type | DT | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 29769-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Date Vis Presented | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | 20150624 | Presence-Content Indifferent |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Element | Data |
|---|---|
| Patient Name | Katherine Mackenzie Benton |
| Mother's Maiden Name | Jones |
| ID Number | 89778 |
| Date/Time of Birth | 12/21/2003 |
| Administrative Sex | Female |
| Patient Address | 89 West 21st Ave Bozeman MT 59715 USA |
| Local Number | (406)555-4019 |
| Race | White |
| Ethnic Group | Not Hispanic or Latino |
| Multiple Birth Indicator | N |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 12/21/2003 |
| Publicity Code | No reminder/recall |
| Publicity Code Effective Date | 06/24/2015 |
| Protection Indicator | Yes |
| Protection Indicator Effective Date | 06/24/2015 |
| Element | Data |
|---|---|
| Name | Kari Michelle Benton |
| Relationship | Mother |
| Address | 89 West 21st Ave Bozeman MT 59715 USA |
| Phone Number | (406)555-4019 |
| Element | Data |
|---|---|
| Administered Code | CERVARIX |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 795441 |
| Substance Expiration Date | 12/23/2015 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Delete |
| Route | Intramuscular |
| Administration Site | Right Deltoid |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Public |
| Vaccine Funding Program Eligibility | VFC Eligible - Underinsured |
| Document Type | Human papillomavirus Vaccine (Cervarix) VIS |
| Date Vis Presented | 06/24/2015 |
| Element | Data |
|---|---|
| Patient Name | Katherine Mackenzie Benton |
| Mother's Maiden Name | Jones |
| ID Number | 89778 |
| Date/Time of Birth | 12/21/2003 |
| Administrative Sex | Female |
| Patient Address | 89 West 21st Ave Bozeman MT 59715 USA |
| Local Number | (406)555-4019 |
| Race | White |
| Ethnic Group | Not Hispanic or Latino |
| Multiple Birth Indicator | N |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 12/21/2003 |
| Publicity Code | No reminder/recall |
| Publicity Code Effective Date | 06/24/2015 |
| Protection Indicator | Yes |
| Protection Indicator Effective Date | 06/24/2015 |
| Element | Data |
|---|---|
| Name | Kari Michelle Benton |
| Relationship | Mother |
| Address | 89 West 21st Ave Bozeman MT 59715 USA |
| Phone Number | (406)555-4019 |
| Element | Data |
|---|---|
| Administered Code | CERVARIX |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 795441 |
| Substance Expiration Date | 12/23/2015 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Delete |
| Route | Intramuscular |
| Administration Site | Right Deltoid |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Public |
| Vaccine Funding Program Eligibility | VFC Eligible - Underinsured |
| Document Type | Human papillomavirus Vaccine (Cervarix) VIS |
| Date Vis Presented | 06/24/2015 |
| Description |
|---|
| The IIS returns a positive acknowledgement message indicating that no errors were found during the course of filing the message. |
| Comments |
|---|
| No Comments |
| Pre Condition |
|---|
| A VXU message is generated by the EHR. |
| Post Condition |
|---|
| No PostCondition |
| Test Objectives |
|---|
| Evaluation Criteria |
|---|
| The acknowledgement message is consumed by the system responsible for the content of the administration message without error. |
| Notes for Testers |
|---|
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | iisApp | Presence-Content Indifferent |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | IIS | Presence-Content Indifferent |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | wcApp | Presence-Content Indifferent |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150624093847.806-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | ACK | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | ACK | Value-Profile Fixed |
| MSH-10 | Message Control ID | 65657 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z23 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | IIS | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | Indifferent | |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | Indifferent | |
| MSH-22.10 | Organization Identifier | Indifferent | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | wcEHR | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | Indifferent | |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | Indifferent | |
| MSH-23.10 | Organization Identifier | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA-1 | Acknowledgment Code | AA | Value-Test Case Fixed |
| MSA-2 | Message Control ID | 71892 | Presence-System Generated |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | iisApp | Presence-Content Indifferent |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | IIS | Presence-Content Indifferent |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | wcApp | Presence-Content Indifferent |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150624093847.806-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | ACK | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | ACK | Value-Profile Fixed |
| MSH-10 | Message Control ID | 65657 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z23 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | IIS | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | Indifferent | |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | Indifferent | |
| MSH-22.10 | Organization Identifier | Indifferent | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | wcEHR | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | Indifferent | |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | Indifferent | |
| MSH-23.10 | Organization Identifier | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA-1 | Acknowledgment Code | AA | Value-Test Case Fixed |
| MSA-2 | Message Control ID | 71892 | Presence-System Generated |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Return an Acknowledgement | |||||
|---|---|---|---|---|---|
| Test Case ID | IZ-AD-4_Delete_Record | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement (Pass/Fail) |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which NO Error is returned in the message.
The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.
| Return an Acknowledgement |
|---|
|
The receiving HIT system being tested shall process the Z23 ACK message correctly; a positive notification indicating that the ACK message was processed correctly need not be made visible in the system. |
| Description |
|---|
| The second child of a set of twins is seen at a clinic. A new vaccinations are administered but an additional one is refused by the parents. |
| Comments |
|---|
| No Comments |
| Pre Condition |
|---|
| No PreCondition |
| Post Condition |
|---|
| No PostCondition |
| Test Objectives |
|---|
| This test case assesses the ability of the EHR to create an administration message for child whose parents have refused an immunization and to support multiple birth indicator and order. |
| Evaluation Criteria |
|---|
| Notes for Testers |
|---|
| No Note |
| Description |
|---|
| A 1 year old male, Tyler Owen Banks, is brought to a clinic for a well child visit. He is accompanied by his father Karl Leonard Banks. Tyler's twin brother, born 5 minutes before Tyler, was not able to make it to the clinic. A clinic staff member collects basic patient demographic information including name, date of birth and sex. A clinic provider, Joe Smith (physician ID 123) reviews the patient's vaccination history and determines that the child requires Hib, Hep A, MMR and Varicella vaccinations. The child is covered by insurance and does not qualify for all Vaccine For Children (VFC) supplied vaccines. The father is given the appropriate Vaccine Information Sheets (VIS) to review. After reading them, the father agrees that the child should receive the Hib, Hep A and MMR vaccines but refuses the Varicella vaccine. He also agrees that the data should be shared once it is incorporated into the local IIS. Appropriate doses of Hib (HIBERIX), Hep A (VAQTA) and MMR (M-M-R II) are selected from the clinic's stock of privately funded vaccines. A clinician, Lily Jackson (ID 456) prepares and administers the doses to the patient and then enters the data into the EHR and transmits it to the IIS. |
| Comments |
|---|
| No Comments |
| Pre Condition |
|---|
| No PreCondition |
| Post Condition |
|---|
| No PostCondition |
| Test Objectives |
|---|
| Evaluation Criteria |
|---|
| Message Validation Report |
| Notes for Testers |
|---|
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | wcApp | Presence-Content Indifferent |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | iisApp | Presence-Content Indifferent |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | IIS | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150624093847.808-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | VXU | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | VXU_V04 | Value-Profile Fixed |
| MSH-10 | Message Control ID | 18019 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | ER | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | AL | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z22 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | wcEHR | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | Indifferent | |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | Indifferent | |
| MSH-22.10 | Organization Identifier | Indifferent | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | IIS | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | Indifferent | |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | Indifferent | |
| MSH-23.10 | Organization Identifier | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID-1 | Set ID - PID | 1 | Value-Profile Fixed |
| PID-3 | Patient Identifier List | ||
| PID-3.1 | ID Number | 8891 | Presence-Content Indifferent |
| PID-3.3 | Check Digit Scheme | Indifferent | |
| PID-3.4 | Assigning Authority | ||
| PID-3.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| PID-3.4.2 | Universal ID | Indifferent | |
| PID-3.4.3 | Universal ID Type | Indifferent | |
| PID-3.5 | Identifier Type Code | MR | Presence-Content Indifferent |
| PID-5 | Patient Name | ||
| PID-5.1 | Family Name | ||
| PID-5.1.1 | Surname | Banks | Presence-Content Indifferent |
| PID-5.1.2 | Own Surname Prefix | ||
| PID-5.1.3 | Own Surname | ||
| PID-5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-5.1.5 | Surname From Partner/Spouse | ||
| PID-5.2 | Given Name | Tyler | Presence-Content Indifferent |
| PID-5.3 | Second and Further Given Names or Initials Thereof | Owen | Presence-Content Indifferent |
| PID-5.7 | Name Type Code | L | Presence-Content Indifferent |
| PID-6 | Mother's Maiden Name | ||
| PID-6.1 | Family Name | ||
| PID-6.1.1 | Surname | Presence-Content Indifferent | |
| PID-6.1.2 | Own Surname Prefix | ||
| PID-6.1.3 | Own Surname | ||
| PID-6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-6.1.5 | Surname From Partner/Spouse | ||
| PID-6.7 | Name Type Code | Value-Profile Fixed | |
| PID-7 | Date/Time of Birth | ||
| PID-7.1 | Time | 20140602 | Presence-Content Indifferent |
| PID-8 | Administrative Sex | M | Presence-Content Indifferent |
| PID-10 | Race | ||
| PID-10.1 | Identifier | 2106-3 | Presence-Content Indifferent |
| PID-10.2 | Text | White | Presence-Content Indifferent |
| PID-10.3 | Name of Coding System | CDCREC | Value-Profile Fixed |
| PID-10.5 | Alternate Text | Indifferent | |
| PID-10.6 | Name of Alternate Coding System | Indifferent | |
| PID-11 | Patient Address | ||
| PID-11.1 | Street Address | ||
| PID-11.1.1 | Street or Mailing Address | 924 Sycamore Lane | Presence-Content Indifferent |
| PID-11.1.2 | Street Name | ||
| PID-11.1.3 | Dwelling Number | ||
| PID-11.2 | Other Designation | Indifferent | |
| PID-11.3 | City | Bozeman | Presence-Content Indifferent |
| PID-11.4 | State or Province | MT | Presence-Content Indifferent |
| PID-11.5 | Zip or Postal Code | 59715 | Presence-Content Indifferent |
| PID-11.6 | Country | USA | Presence-Content Indifferent |
| PID-11.7 | Address Type | P | Presence-Content Indifferent |
| PID-13 | Phone Number - Home | ||
| PID-13.2 | Telecommunication Use Code | PRN | Presence-Content Indifferent |
| PID-13.3 | Telecommunication Equipment Type | PH | Value-Test Case Fixed |
| PID-13.4 | Email Address | NonPresence | |
| PID-13.6 | Area/City Code | 406 | Presence-Content Indifferent |
| PID-13.7 | Local Number | 5555835 | Presence-Content Indifferent |
| PID-22 | Ethnic Group | ||
| PID-22.1 | Identifier | 2186-5 | Presence-Content Indifferent |
| PID-22.2 | Text | Not Hispanic or Latino | Presence-Content Indifferent |
| PID-22.3 | Name of Coding System | CDCREC | Value-Profile Fixed |
| PID-22.5 | Alternate Text | Indifferent | |
| PID-22.6 | Name of Alternate Coding System | Indifferent | |
| PID-24 | Multiple Birth Indicator | Y | Value-Test Case Fixed |
| PID-25 | Birth Order | 2 | Value-Test Case Fixed |
| PID-29 | Patient Death Date and Time | ||
| PID-29.1 | Time | Indifferent | |
| PID-30 | Patient Death Indicator | N | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1-11 | Publicity Code | ||
| PD1-11.1 | Identifier | 02 | Presence-Content Indifferent |
| PD1-11.2 | Text | Reminder/recall - any method | Presence-Content Indifferent |
| PD1-11.3 | Name of Coding System | HL70215 | Value-Profile Fixed |
| PD1-11.5 | Alternate Text | Indifferent | |
| PD1-11.6 | Name of Alternate Coding System | Indifferent | |
| PD1-12 | Protection Indicator | N | Value-Test Case Fixed |
| PD1-13 | Protection Indicator Effective Date | 20150624 | Presence-Content Indifferent |
| PD1-16 | Immunization Registry Status | A | Presence-Content Indifferent |
| PD1-17 | Immunization Registry Status Effective Date | 20040602 | Presence-Content Indifferent |
| PD1-18 | Publicity Code Effective Date | 20150624 | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| NK1-1 | Set ID - NK1 | 1 | Value-Profile Fixed |
| NK1-2 | Name | ||
| NK1-2.1 | Family Name | ||
| NK1-2.1.1 | Surname | Banks | Presence-Content Indifferent |
| NK1-2.1.2 | Own Surname Prefix | ||
| NK1-2.1.3 | Own Surname | ||
| NK1-2.1.4 | Surname Prefix From Partner/Spouse | ||
| NK1-2.1.5 | Surname From Partner/Spouse | ||
| NK1-2.2 | Given Name | Karl | Presence-Content Indifferent |
| NK1-2.3 | Second and Further Given Names or Initials Thereof | Leonard | Presence-Content Indifferent |
| NK1-2.7 | Name Type Code | L | Presence-Content Indifferent |
| NK1-3 | Relationship | ||
| NK1-3.1 | Identifier | FTH | Presence-Content Indifferent |
| NK1-3.2 | Text | Father | Presence-Content Indifferent |
| NK1-3.3 | Name of Coding System | HL70063 | Value-Profile Fixed |
| NK1-3.5 | Alternate Text | Indifferent | |
| NK1-3.6 | Name of Alternate Coding System | Indifferent | |
| NK1-4 | Address | ||
| NK1-4.1 | Street Address | ||
| NK1-4.1.1 | Street or Mailing Address | 924 Sycamore Lane | Presence-Content Indifferent |
| NK1-4.1.2 | Street Name | ||
| NK1-4.1.3 | Dwelling Number | ||
| NK1-4.2 | Other Designation | Indifferent | |
| NK1-4.3 | City | Bozeman | Presence-Content Indifferent |
| NK1-4.4 | State or Province | MT | Presence-Content Indifferent |
| NK1-4.5 | Zip or Postal Code | 59715 | Presence-Content Indifferent |
| NK1-4.6 | Country | USA | Presence-Content Indifferent |
| NK1-4.7 | Address Type | P | Presence-Content Indifferent |
| NK1-5 | Phone Number | ||
| NK1-5.2 | Telecommunication Use Code | PRN | Presence-Content Indifferent |
| NK1-5.3 | Telecommunication Equipment Type | PH | Value-Test Case Fixed |
| NK1-5.4 | Email Address | NonPresence | |
| NK1-5.6 | Area/City Code | 406 | Presence-Content Indifferent |
| NK1-5.7 | Local Number | 5555835 | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | Value-Profile Fixed |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | 5645 | Presence-Content Indifferent |
| ORC-2.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-2.3 | Universal ID | Indifferent | |
| ORC-2.4 | Universal ID Type | Indifferent | |
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 22515 | Presence-Content Indifferent |
| ORC-3.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-3.3 | Universal ID | Indifferent | |
| ORC-3.4 | Universal ID Type | Indifferent | |
| ORC-10 | Entered By | ||
| ORC-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| ORC-10.2 | Family Name | ||
| ORC-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| ORC-10.2.2 | Own Surname Prefix | ||
| ORC-10.2.3 | Own Surname | ||
| ORC-10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-10.2.5 | Surname From Partner/Spouse | ||
| ORC-10.3 | Given Name | Lily | Presence-Content Indifferent |
| ORC-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| ORC-10.9 | Assigning Authority | ||
| ORC-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-10.9.2 | Universal ID | ||
| ORC-10.9.3 | Universal ID Type | ||
| ORC-10.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-10.12 | Check Digit Scheme | Indifferent | |
| ORC-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| ORC-12 | Ordering Provider | ||
| ORC-12.1 | ID Number | 654 | Presence-Content Indifferent |
| ORC-12.2 | Family Name | ||
| ORC-12.2.1 | Surname | Thomas | Presence-Content Indifferent |
| ORC-12.2.2 | Own Surname Prefix | ||
| ORC-12.2.3 | Own Surname | ||
| ORC-12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-12.2.5 | Surname From Partner/Spouse | ||
| ORC-12.3 | Given Name | Wilma | Presence-Content Indifferent |
| ORC-12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | Presence-Content Indifferent |
| ORC-12.9 | Assigning Authority | ||
| ORC-12.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-12.9.2 | Universal ID | ||
| ORC-12.9.3 | Universal ID Type | ||
| ORC-12.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-12.12 | Check Digit Scheme | Indifferent | |
| ORC-12.13 | Identifier Type Code | MD | Presence-Content Indifferent |
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | wcEHR | Presence-Content Indifferent |
| ORC-17.2 | Text | West Clinic | Presence-Content Indifferent |
| ORC-17.3 | Name of Coding System | HL70362 | Value-Profile Fixed |
| ORC-17.5 | Alternate Text | Indifferent | |
| ORC-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | Value-Profile Fixed |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | 5027 | Presence-Content Indifferent |
| ORC-2.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-2.3 | Universal ID | Indifferent | |
| ORC-2.4 | Universal ID Type | Indifferent | |
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 12128 | Presence-Content Indifferent |
| ORC-3.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-3.3 | Universal ID | Indifferent | |
| ORC-3.4 | Universal ID Type | Indifferent | |
| ORC-10 | Entered By | ||
| ORC-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| ORC-10.2 | Family Name | ||
| ORC-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| ORC-10.2.2 | Own Surname Prefix | ||
| ORC-10.2.3 | Own Surname | ||
| ORC-10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-10.2.5 | Surname From Partner/Spouse | ||
| ORC-10.3 | Given Name | Lily | Presence-Content Indifferent |
| ORC-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| ORC-10.9 | Assigning Authority | ||
| ORC-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-10.9.2 | Universal ID | ||
| ORC-10.9.3 | Universal ID Type | ||
| ORC-10.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-10.12 | Check Digit Scheme | Indifferent | |
| ORC-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| ORC-12 | Ordering Provider | ||
| ORC-12.1 | ID Number | 654 | Presence-Content Indifferent |
| ORC-12.2 | Family Name | ||
| ORC-12.2.1 | Surname | Thomas | Presence-Content Indifferent |
| ORC-12.2.2 | Own Surname Prefix | ||
| ORC-12.2.3 | Own Surname | ||
| ORC-12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-12.2.5 | Surname From Partner/Spouse | ||
| ORC-12.3 | Given Name | Wilma | Presence-Content Indifferent |
| ORC-12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | Presence-Content Indifferent |
| ORC-12.9 | Assigning Authority | ||
| ORC-12.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-12.9.2 | Universal ID | ||
| ORC-12.9.3 | Universal ID Type | ||
| ORC-12.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-12.12 | Check Digit Scheme | Indifferent | |
| ORC-12.13 | Identifier Type Code | MD | Presence-Content Indifferent |
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | wcEHR | Presence-Content Indifferent |
| ORC-17.2 | Text | West Clinic | Presence-Content Indifferent |
| ORC-17.3 | Name of Coding System | HL70362 | Value-Profile Fixed |
| ORC-17.5 | Alternate Text | Indifferent | |
| ORC-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | Value-Profile Fixed |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | 7239 | Presence-Content Indifferent |
| ORC-2.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-2.3 | Universal ID | Indifferent | |
| ORC-2.4 | Universal ID Type | Indifferent | |
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 50588 | Presence-Content Indifferent |
| ORC-3.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-3.3 | Universal ID | Indifferent | |
| ORC-3.4 | Universal ID Type | Indifferent | |
| ORC-10 | Entered By | ||
| ORC-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| ORC-10.2 | Family Name | ||
| ORC-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| ORC-10.2.2 | Own Surname Prefix | ||
| ORC-10.2.3 | Own Surname | ||
| ORC-10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-10.2.5 | Surname From Partner/Spouse | ||
| ORC-10.3 | Given Name | Lily | Presence-Content Indifferent |
| ORC-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| ORC-10.9 | Assigning Authority | ||
| ORC-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-10.9.2 | Universal ID | ||
| ORC-10.9.3 | Universal ID Type | ||
| ORC-10.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-10.12 | Check Digit Scheme | Indifferent | |
| ORC-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| ORC-12 | Ordering Provider | ||
| ORC-12.1 | ID Number | 654 | Presence-Content Indifferent |
| ORC-12.2 | Family Name | ||
| ORC-12.2.1 | Surname | Thomas | Presence-Content Indifferent |
| ORC-12.2.2 | Own Surname Prefix | ||
| ORC-12.2.3 | Own Surname | ||
| ORC-12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-12.2.5 | Surname From Partner/Spouse | ||
| ORC-12.3 | Given Name | Wilma | Presence-Content Indifferent |
| ORC-12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | Presence-Content Indifferent |
| ORC-12.9 | Assigning Authority | ||
| ORC-12.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-12.9.2 | Universal ID | ||
| ORC-12.9.3 | Universal ID Type | ||
| ORC-12.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-12.12 | Check Digit Scheme | Indifferent | |
| ORC-12.13 | Identifier Type Code | MD | Presence-Content Indifferent |
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | wcEHR | Presence-Content Indifferent |
| ORC-17.2 | Text | West Clinic | Presence-Content Indifferent |
| ORC-17.3 | Name of Coding System | HL70362 | Value-Profile Fixed |
| ORC-17.5 | Alternate Text | Indifferent | |
| ORC-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | Value-Profile Fixed |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | Indifferent | |
| ORC-2.2 | Namespace ID | Indifferent | |
| ORC-2.3 | Universal ID | Indifferent | |
| ORC-2.4 | Universal ID Type | Indifferent | |
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 9999 | Presence-Content Indifferent |
| ORC-3.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-3.3 | Universal ID | Indifferent | |
| ORC-3.4 | Universal ID Type | Indifferent | |
| ORC-10 | Entered By | ||
| ORC-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| ORC-10.2 | Family Name | ||
| ORC-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| ORC-10.2.2 | Own Surname Prefix | ||
| ORC-10.2.3 | Own Surname | ||
| ORC-10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-10.2.5 | Surname From Partner/Spouse | ||
| ORC-10.3 | Given Name | Lily | Presence-Content Indifferent |
| ORC-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| ORC-10.9 | Assigning Authority | ||
| ORC-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-10.9.2 | Universal ID | ||
| ORC-10.9.3 | Universal ID Type | ||
| ORC-10.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-10.12 | Check Digit Scheme | Indifferent | |
| ORC-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| ORC-12 | Ordering Provider | ||
| ORC-12.1 | ID Number | Indifferent | |
| ORC-12.2 | Family Name | ||
| ORC-12.2.1 | Surname | Indifferent | |
| ORC-12.2.2 | Own Surname Prefix | ||
| ORC-12.2.3 | Own Surname | ||
| ORC-12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-12.2.5 | Surname From Partner/Spouse | ||
| ORC-12.3 | Given Name | Indifferent | |
| ORC-12.4 | Second and Further Given Names or Initials Thereof | Indifferent | |
| ORC-12.9 | Assigning Authority | ||
| ORC-12.9.1 | Namespace ID | Indifferent | |
| ORC-12.9.2 | Universal ID | Indifferent | |
| ORC-12.9.3 | Universal ID Type | Indifferent | |
| ORC-12.10 | Name Type Code | Indifferent | |
| ORC-12.12 | Check Digit Scheme | Indifferent | |
| ORC-12.13 | Identifier Type Code | Indifferent | |
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | wcEHR | Presence-Content Indifferent |
| ORC-17.2 | Text | West Clinic | Presence-Content Indifferent |
| ORC-17.3 | Name of Coding System | HL70362 | Value-Profile Fixed |
| ORC-17.5 | Alternate Text | Indifferent | |
| ORC-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | Value-Profile Fixed |
| RXA-2 | Administration Sub-ID Counter | 1 | Value-Profile Fixed |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20150624 | Presence-Content Indifferent |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 58160-0806-01 | Value-Test Case Fixed |
| RXA-5.2 | Text | HIBERIX | Presence-Content Indifferent |
| RXA-5.3 | Name of Coding System | NDC | Value-Test Case Fixed |
| RXA-5.5 | Alternate Text | Indifferent | |
| RXA-5.6 | Name of Alternate Coding System | Indifferent | |
| RXA-6 | Administered Amount | 0.5 | Value-Test Case Fixed |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | mL | Value-Test Case Fixed |
| RXA-7.2 | Text | mL | Presence-Content Indifferent |
| RXA-7.3 | Name of Coding System | UCUM | Value-Test Case Fixed |
| RXA-7.5 | Alternate Text | Indifferent | |
| RXA-7.6 | Name of Alternate Coding System | Indifferent | |
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 00 | Value-Test Case Fixed |
| RXA-9.2 | Text | New Record | Presence-Content Indifferent |
| RXA-9.3 | Name of Coding System | NIP001 | Value-Profile Fixed |
| RXA-9.5 | Alternate Text | Indifferent | |
| RXA-9.6 | Name of Alternate Coding System | Indifferent | |
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Lily | Presence-Content Indifferent |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | L | Presence-Content Indifferent |
| RXA-10.12 | Check Digit Scheme | Indifferent | |
| RXA-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-11.4.2 | Universal ID | Indifferent | |
| RXA-11.4.3 | Universal ID Type | Indifferent | |
| RXA-15 | Substance Lot Number | 328734 | Presence-Content Indifferent |
| RXA-16 | Substance Expiration Date | ||
| RXA-16.1 | Time | 20150923 | Presence-Content Indifferent |
| RXA-17 | Substance Manufacturer Name | ||
| RXA-17.1 | Identifier | SKB | Presence-Content Indifferent |
| RXA-17.2 | Text | GlaxoSmithKline | Presence-Content Indifferent |
| RXA-17.3 | Name of Coding System | MVX | Value-Test Case Fixed |
| RXA-17.5 | Alternate Text | Indifferent | |
| RXA-17.6 | Name of Alternate Coding System | Indifferent | |
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | Indifferent | |
| RXA-18.2 | Text | Indifferent | |
| RXA-18.3 | Name of Coding System | Indifferent | |
| RXA-18.5 | Alternate Text | Indifferent | |
| RXA-18.6 | Name of Alternate Coding System | Indifferent | |
| RXA-20 | Completion Status | CP | Value-Test Case Fixed |
| RXA-21 | Action Code - RXA | A | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | Value-Profile Fixed |
| RXA-2 | Administration Sub-ID Counter | 1 | Value-Profile Fixed |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20150624 | Presence-Content Indifferent |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 00006-4095-01 | Value-Test Case Fixed |
| RXA-5.2 | Text | VAQTA | Presence-Content Indifferent |
| RXA-5.3 | Name of Coding System | NDC | Value-Test Case Fixed |
| RXA-5.5 | Alternate Text | Indifferent | |
| RXA-5.6 | Name of Alternate Coding System | Indifferent | |
| RXA-6 | Administered Amount | 0.5 | Value-Test Case Fixed |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | mL | Value-Test Case Fixed |
| RXA-7.2 | Text | mL | Presence-Content Indifferent |
| RXA-7.3 | Name of Coding System | UCUM | Value-Test Case Fixed |
| RXA-7.5 | Alternate Text | Indifferent | |
| RXA-7.6 | Name of Alternate Coding System | Indifferent | |
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 00 | Value-Test Case Fixed |
| RXA-9.2 | Text | New Record | Presence-Content Indifferent |
| RXA-9.3 | Name of Coding System | NIP001 | Value-Profile Fixed |
| RXA-9.5 | Alternate Text | Indifferent | |
| RXA-9.6 | Name of Alternate Coding System | Indifferent | |
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Lily | Presence-Content Indifferent |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | L | Presence-Content Indifferent |
| RXA-10.12 | Check Digit Scheme | Indifferent | |
| RXA-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-11.4.2 | Universal ID | Indifferent | |
| RXA-11.4.3 | Universal ID Type | Indifferent | |
| RXA-15 | Substance Lot Number | 208940 | Presence-Content Indifferent |
| RXA-16 | Substance Expiration Date | ||
| RXA-16.1 | Time | 20160120 | Presence-Content Indifferent |
| RXA-17 | Substance Manufacturer Name | ||
| RXA-17.1 | Identifier | MSD | Presence-Content Indifferent |
| RXA-17.2 | Text | Merck and Co., Inc. | Presence-Content Indifferent |
| RXA-17.3 | Name of Coding System | MVX | Value-Test Case Fixed |
| RXA-17.5 | Alternate Text | Indifferent | |
| RXA-17.6 | Name of Alternate Coding System | Indifferent | |
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | Indifferent | |
| RXA-18.2 | Text | Indifferent | |
| RXA-18.3 | Name of Coding System | Indifferent | |
| RXA-18.5 | Alternate Text | Indifferent | |
| RXA-18.6 | Name of Alternate Coding System | Indifferent | |
| RXA-20 | Completion Status | CP | Value-Test Case Fixed |
| RXA-21 | Action Code - RXA | A | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | Value-Profile Fixed |
| RXA-2 | Administration Sub-ID Counter | 1 | Value-Profile Fixed |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20150624 | Presence-Content Indifferent |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 00006-4681-01 | Value-Test Case Fixed |
| RXA-5.2 | Text | M-M-R II | Presence-Content Indifferent |
| RXA-5.3 | Name of Coding System | NDC | Value-Test Case Fixed |
| RXA-5.5 | Alternate Text | Indifferent | |
| RXA-5.6 | Name of Alternate Coding System | Indifferent | |
| RXA-6 | Administered Amount | 0.5 | Value-Test Case Fixed |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | mL | Value-Test Case Fixed |
| RXA-7.2 | Text | mL | Presence-Content Indifferent |
| RXA-7.3 | Name of Coding System | UCUM | Value-Test Case Fixed |
| RXA-7.5 | Alternate Text | Indifferent | |
| RXA-7.6 | Name of Alternate Coding System | Indifferent | |
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 00 | Value-Test Case Fixed |
| RXA-9.2 | Text | New Record | Presence-Content Indifferent |
| RXA-9.3 | Name of Coding System | NIP001 | Value-Profile Fixed |
| RXA-9.5 | Alternate Text | Indifferent | |
| RXA-9.6 | Name of Alternate Coding System | Indifferent | |
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Lily | Presence-Content Indifferent |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | L | Presence-Content Indifferent |
| RXA-10.12 | Check Digit Scheme | Indifferent | |
| RXA-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-11.4.2 | Universal ID | Indifferent | |
| RXA-11.4.3 | Universal ID Type | Indifferent | |
| RXA-15 | Substance Lot Number | 134301 | Presence-Content Indifferent |
| RXA-16 | Substance Expiration Date | ||
| RXA-16.1 | Time | 20151028 | Presence-Content Indifferent |
| RXA-17 | Substance Manufacturer Name | ||
| RXA-17.1 | Identifier | MSD | Presence-Content Indifferent |
| RXA-17.2 | Text | Merck and Co., Inc. | Presence-Content Indifferent |
| RXA-17.3 | Name of Coding System | MVX | Value-Test Case Fixed |
| RXA-17.5 | Alternate Text | Indifferent | |
| RXA-17.6 | Name of Alternate Coding System | Indifferent | |
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | Indifferent | |
| RXA-18.2 | Text | Indifferent | |
| RXA-18.3 | Name of Coding System | Indifferent | |
| RXA-18.5 | Alternate Text | Indifferent | |
| RXA-18.6 | Name of Alternate Coding System | Indifferent | |
| RXA-20 | Completion Status | CP | Value-Test Case Fixed |
| RXA-21 | Action Code - RXA | A | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | Value-Profile Fixed |
| RXA-2 | Administration Sub-ID Counter | 1 | Value-Profile Fixed |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20150624 | Presence-Content Indifferent |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 21 | Value-Test Case Fixed |
| RXA-5.2 | Text | varicella | Presence-Content Indifferent |
| RXA-5.3 | Name of Coding System | CVX | Value-Test Case Fixed |
| RXA-5.5 | Alternate Text | Indifferent | |
| RXA-5.6 | Name of Alternate Coding System | Indifferent | |
| RXA-6 | Administered Amount | 999 | Value-Test Case Fixed |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | NonPresence | |
| RXA-7.2 | Text | NonPresence | |
| RXA-7.3 | Name of Coding System | NonPresence | |
| RXA-7.5 | Alternate Text | NonPresence | |
| RXA-7.6 | Name of Alternate Coding System | NonPresence | |
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | Indifferent | |
| RXA-9.2 | Text | Indifferent | |
| RXA-9.3 | Name of Coding System | Indifferent | |
| RXA-9.5 | Alternate Text | Indifferent | |
| RXA-9.6 | Name of Alternate Coding System | Indifferent | |
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | Indifferent | |
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Indifferent | |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Indifferent | |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | Indifferent | |
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | Indifferent | |
| RXA-10.9.2 | Universal ID | Indifferent | |
| RXA-10.9.3 | Universal ID Type | Indifferent | |
| RXA-10.10 | Name Type Code | Indifferent | |
| RXA-10.12 | Check Digit Scheme | Indifferent | |
| RXA-10.13 | Identifier Type Code | Indifferent | |
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | Presence-Content Indifferent | |
| RXA-11.4.2 | Universal ID | Indifferent | |
| RXA-11.4.3 | Universal ID Type | Indifferent | |
| RXA-15 | Substance Lot Number | Indifferent | |
| RXA-16 | Substance Expiration Date | ||
| RXA-16.1 | Time | Indifferent | |
| RXA-17 | Substance Manufacturer Name | ||
| RXA-17.1 | Identifier | Indifferent | |
| RXA-17.2 | Text | Indifferent | |
| RXA-17.3 | Name of Coding System | Indifferent | |
| RXA-17.5 | Alternate Text | Indifferent | |
| RXA-17.6 | Name of Alternate Coding System | Indifferent | |
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | 00 | Value-Test Case Fixed |
| RXA-18.2 | Text | Parental decision | Presence-Content Indifferent |
| RXA-18.3 | Name of Coding System | NIP002 | Value-Profile Fixed |
| RXA-18.5 | Alternate Text | Indifferent | |
| RXA-18.6 | Name of Alternate Coding System | Indifferent | |
| RXA-20 | Completion Status | RE | Value-Test Case Fixed |
| RXA-21 | Action Code - RXA | A | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR-1 | Route | ||
| RXR-1.1 | Identifier | C28161 | Presence-Content Indifferent |
| RXR-1.2 | Text | Intramuscular | Presence-Content Indifferent |
| RXR-1.3 | Name of Coding System | NCIT | Value-Profile Fixed |
| RXR-1.5 | Alternate Text | Indifferent | |
| RXR-1.6 | Name of Alternate Coding System | Indifferent | |
| RXR-2 | Administration Site | ||
| RXR-2.1 | Identifier | RT | Presence-Content Indifferent |
| RXR-2.2 | Text | Right Thigh | Presence-Content Indifferent |
| RXR-2.3 | Name of Coding System | HL70163 | Value-Profile Fixed |
| RXR-2.5 | Alternate Text | Indifferent | |
| RXR-2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR-1 | Route | ||
| RXR-1.1 | Identifier | C28161 | Presence-Content Indifferent |
| RXR-1.2 | Text | Intramuscular | Presence-Content Indifferent |
| RXR-1.3 | Name of Coding System | NCIT | Value-Profile Fixed |
| RXR-1.5 | Alternate Text | Indifferent | |
| RXR-1.6 | Name of Alternate Coding System | Indifferent | |
| RXR-2 | Administration Site | ||
| RXR-2.1 | Identifier | RT | Presence-Content Indifferent |
| RXR-2.2 | Text | Right Thigh | Presence-Content Indifferent |
| RXR-2.3 | Name of Coding System | HL70163 | Value-Profile Fixed |
| RXR-2.5 | Alternate Text | Indifferent | |
| RXR-2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR-1 | Route | ||
| RXR-1.1 | Identifier | C38299 | Presence-Content Indifferent |
| RXR-1.2 | Text | Subcutaneous | Presence-Content Indifferent |
| RXR-1.3 | Name of Coding System | NCIT | Value-Profile Fixed |
| RXR-1.5 | Alternate Text | Indifferent | |
| RXR-1.6 | Name of Alternate Coding System | Indifferent | |
| RXR-2 | Administration Site | ||
| RXR-2.1 | Identifier | LT | Presence-Content Indifferent |
| RXR-2.2 | Text | Left Thigh | Presence-Content Indifferent |
| RXR-2.3 | Name of Coding System | HL70163 | Value-Profile Fixed |
| RXR-2.5 | Alternate Text | Indifferent | |
| RXR-2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 1 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30963-3 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Source | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 1 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-5.1 | Identifier | PHC70 | |
| OBX-5.2 | Text | Private | |
| OBX-5.3 | Name of Coding System | CDCPHINVS | |
| OBX-5.5 | Alternate Text | ||
| OBX-5.6 | Name of Alternate Coding System | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 2 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 64994-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Program Eligibility | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 2 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-5.1 | Identifier | V01 | |
| OBX-5.2 | Text | Not VFC Eligible | |
| OBX-5.3 | Name of Coding System | HL70064 | |
| OBX-5.5 | Alternate Text | ||
| OBX-5.6 | Name of Alternate Coding System | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | VXC40 | Value-Test Case Fixed |
| OBX-17.2 | Text | per immunization | Presence-Content Indifferent |
| OBX-17.3 | Name of Coding System | CDCPHINVS | Value-Profile Fixed |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 3 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 69764-9 | Value-Test Case Fixed |
| OBX-3.2 | Text | Document Type | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-5.1 | Identifier | 253088698300026411141022 | |
| OBX-5.2 | Text | Multiple Vaccines VIS | |
| OBX-5.3 | Name of Coding System | cdcgs1vis | |
| OBX-5.5 | Alternate Text | ||
| OBX-5.6 | Name of Alternate Coding System | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 4 | Value-Profile Fixed |
| OBX-2 | Value Type | DT | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 29769-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Date Vis Presented | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | 20150624 | Presence-Content Indifferent |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 1 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30963-3 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Source | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 1 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-5.1 | Identifier | PHC70 | |
| OBX-5.2 | Text | Private | |
| OBX-5.3 | Name of Coding System | CDCPHINVS | |
| OBX-5.5 | Alternate Text | ||
| OBX-5.6 | Name of Alternate Coding System | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 2 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 64994-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Program Eligibility | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 2 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-5.1 | Identifier | V01 | |
| OBX-5.2 | Text | Not VFC Eligible | |
| OBX-5.3 | Name of Coding System | HL70064 | |
| OBX-5.5 | Alternate Text | ||
| OBX-5.6 | Name of Alternate Coding System | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | VXC40 | Value-Test Case Fixed |
| OBX-17.2 | Text | per immunization | Presence-Content Indifferent |
| OBX-17.3 | Name of Coding System | CDCPHINVS | Value-Profile Fixed |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 3 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 69764-9 | Value-Test Case Fixed |
| OBX-3.2 | Text | Document Type | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-5.1 | Identifier | 253088698300004211111025 | |
| OBX-5.2 | Text | Hepatitis A VIS | |
| OBX-5.3 | Name of Coding System | cdcgs1vis | |
| OBX-5.5 | Alternate Text | ||
| OBX-5.6 | Name of Alternate Coding System | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 4 | Value-Profile Fixed |
| OBX-2 | Value Type | DT | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 29769-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Date Vis Presented | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | 20150624 | Presence-Content Indifferent |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 1 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30963-3 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Source | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 1 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-5.1 | Identifier | PHC70 | |
| OBX-5.2 | Text | Private | |
| OBX-5.3 | Name of Coding System | CDCPHINVS | |
| OBX-5.5 | Alternate Text | ||
| OBX-5.6 | Name of Alternate Coding System | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 2 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 64994-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Program Eligibility | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 2 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-5.1 | Identifier | V01 | |
| OBX-5.2 | Text | Not VFC Eligible | |
| OBX-5.3 | Name of Coding System | HL70064 | |
| OBX-5.5 | Alternate Text | ||
| OBX-5.6 | Name of Alternate Coding System | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | VXC40 | Value-Test Case Fixed |
| OBX-17.2 | Text | per immunization | Presence-Content Indifferent |
| OBX-17.3 | Name of Coding System | CDCPHINVS | Value-Profile Fixed |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 3 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 69764-9 | Value-Test Case Fixed |
| OBX-3.2 | Text | Document Type | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-5.1 | Identifier | 253088698300012711120420 | |
| OBX-5.2 | Text | Measles/Mumps/Rubella VIS | |
| OBX-5.3 | Name of Coding System | cdcgs1vis | |
| OBX-5.5 | Alternate Text | ||
| OBX-5.6 | Name of Alternate Coding System | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 4 | Value-Profile Fixed |
| OBX-2 | Value Type | DT | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 29769-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Date Vis Presented | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | 20150624 | Presence-Content Indifferent |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | wcApp | Presence-Content Indifferent |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | iisApp | Presence-Content Indifferent |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | IIS | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150624093847.808-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | VXU | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | VXU_V04 | Value-Profile Fixed |
| MSH-10 | Message Control ID | 18019 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | ER | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | AL | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z22 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | wcEHR | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | Indifferent | |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | Indifferent | |
| MSH-22.10 | Organization Identifier | Indifferent | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | IIS | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | Indifferent | |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | Indifferent | |
| MSH-23.10 | Organization Identifier | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID-1 | Set ID - PID | 1 | Value-Profile Fixed |
| PID-3 | Patient Identifier List | ||
| PID-3.1 | ID Number | 8891 | Presence-Content Indifferent |
| PID-3.3 | Check Digit Scheme | Indifferent | |
| PID-3.4 | Assigning Authority | ||
| PID-3.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| PID-3.4.2 | Universal ID | Indifferent | |
| PID-3.4.3 | Universal ID Type | Indifferent | |
| PID-3.5 | Identifier Type Code | MR | Presence-Content Indifferent |
| PID-5 | Patient Name | ||
| PID-5.1 | Family Name | ||
| PID-5.1.1 | Surname | Banks | Presence-Content Indifferent |
| PID-5.1.2 | Own Surname Prefix | ||
| PID-5.1.3 | Own Surname | ||
| PID-5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-5.1.5 | Surname From Partner/Spouse | ||
| PID-5.2 | Given Name | Tyler | Presence-Content Indifferent |
| PID-5.3 | Second and Further Given Names or Initials Thereof | Owen | Presence-Content Indifferent |
| PID-5.7 | Name Type Code | L | Presence-Content Indifferent |
| PID-6 | Mother's Maiden Name | ||
| PID-6.1 | Family Name | ||
| PID-6.1.1 | Surname | Presence-Content Indifferent | |
| PID-6.1.2 | Own Surname Prefix | ||
| PID-6.1.3 | Own Surname | ||
| PID-6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-6.1.5 | Surname From Partner/Spouse | ||
| PID-6.7 | Name Type Code | Value-Profile Fixed | |
| PID-7 | Date/Time of Birth | ||
| PID-7.1 | Time | 20140602 | Presence-Content Indifferent |
| PID-8 | Administrative Sex | M | Presence-Content Indifferent |
| PID-10 | Race | ||
| PID-10.1 | Identifier | 2106-3 | Presence-Content Indifferent |
| PID-10.2 | Text | White | Presence-Content Indifferent |
| PID-10.3 | Name of Coding System | CDCREC | Value-Profile Fixed |
| PID-10.5 | Alternate Text | Indifferent | |
| PID-10.6 | Name of Alternate Coding System | Indifferent | |
| PID-11 | Patient Address | ||
| PID-11.1 | Street Address | ||
| PID-11.1.1 | Street or Mailing Address | 924 Sycamore Lane | Presence-Content Indifferent |
| PID-11.1.2 | Street Name | ||
| PID-11.1.3 | Dwelling Number | ||
| PID-11.2 | Other Designation | Indifferent | |
| PID-11.3 | City | Bozeman | Presence-Content Indifferent |
| PID-11.4 | State or Province | MT | Presence-Content Indifferent |
| PID-11.5 | Zip or Postal Code | 59715 | Presence-Content Indifferent |
| PID-11.6 | Country | USA | Presence-Content Indifferent |
| PID-11.7 | Address Type | P | Presence-Content Indifferent |
| PID-13 | Phone Number - Home | ||
| PID-13.2 | Telecommunication Use Code | PRN | Presence-Content Indifferent |
| PID-13.3 | Telecommunication Equipment Type | PH | Value-Test Case Fixed |
| PID-13.4 | Email Address | NonPresence | |
| PID-13.6 | Area/City Code | 406 | Presence-Content Indifferent |
| PID-13.7 | Local Number | 5555835 | Presence-Content Indifferent |
| PID-22 | Ethnic Group | ||
| PID-22.1 | Identifier | 2186-5 | Presence-Content Indifferent |
| PID-22.2 | Text | Not Hispanic or Latino | Presence-Content Indifferent |
| PID-22.3 | Name of Coding System | CDCREC | Value-Profile Fixed |
| PID-22.5 | Alternate Text | Indifferent | |
| PID-22.6 | Name of Alternate Coding System | Indifferent | |
| PID-24 | Multiple Birth Indicator | Y | Value-Test Case Fixed |
| PID-25 | Birth Order | 2 | Value-Test Case Fixed |
| PID-29 | Patient Death Date and Time | ||
| PID-29.1 | Time | Indifferent | |
| PID-30 | Patient Death Indicator | N | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1-11 | Publicity Code | ||
| PD1-11.1 | Identifier | 02 | Presence-Content Indifferent |
| PD1-11.2 | Text | Reminder/recall - any method | Presence-Content Indifferent |
| PD1-11.3 | Name of Coding System | HL70215 | Value-Profile Fixed |
| PD1-11.5 | Alternate Text | Indifferent | |
| PD1-11.6 | Name of Alternate Coding System | Indifferent | |
| PD1-12 | Protection Indicator | N | Value-Test Case Fixed |
| PD1-13 | Protection Indicator Effective Date | 20150624 | Presence-Content Indifferent |
| PD1-16 | Immunization Registry Status | A | Presence-Content Indifferent |
| PD1-17 | Immunization Registry Status Effective Date | 20040602 | Presence-Content Indifferent |
| PD1-18 | Publicity Code Effective Date | 20150624 | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| NK1-1 | Set ID - NK1 | 1 | Value-Profile Fixed |
| NK1-2 | Name | ||
| NK1-2.1 | Family Name | ||
| NK1-2.1.1 | Surname | Banks | Presence-Content Indifferent |
| NK1-2.1.2 | Own Surname Prefix | ||
| NK1-2.1.3 | Own Surname | ||
| NK1-2.1.4 | Surname Prefix From Partner/Spouse | ||
| NK1-2.1.5 | Surname From Partner/Spouse | ||
| NK1-2.2 | Given Name | Karl | Presence-Content Indifferent |
| NK1-2.3 | Second and Further Given Names or Initials Thereof | Leonard | Presence-Content Indifferent |
| NK1-2.7 | Name Type Code | L | Presence-Content Indifferent |
| NK1-3 | Relationship | ||
| NK1-3.1 | Identifier | FTH | Presence-Content Indifferent |
| NK1-3.2 | Text | Father | Presence-Content Indifferent |
| NK1-3.3 | Name of Coding System | HL70063 | Value-Profile Fixed |
| NK1-3.5 | Alternate Text | Indifferent | |
| NK1-3.6 | Name of Alternate Coding System | Indifferent | |
| NK1-4 | Address | ||
| NK1-4.1 | Street Address | ||
| NK1-4.1.1 | Street or Mailing Address | 924 Sycamore Lane | Presence-Content Indifferent |
| NK1-4.1.2 | Street Name | ||
| NK1-4.1.3 | Dwelling Number | ||
| NK1-4.2 | Other Designation | Indifferent | |
| NK1-4.3 | City | Bozeman | Presence-Content Indifferent |
| NK1-4.4 | State or Province | MT | Presence-Content Indifferent |
| NK1-4.5 | Zip or Postal Code | 59715 | Presence-Content Indifferent |
| NK1-4.6 | Country | USA | Presence-Content Indifferent |
| NK1-4.7 | Address Type | P | Presence-Content Indifferent |
| NK1-5 | Phone Number | ||
| NK1-5.2 | Telecommunication Use Code | PRN | Presence-Content Indifferent |
| NK1-5.3 | Telecommunication Equipment Type | PH | Value-Test Case Fixed |
| NK1-5.4 | Email Address | NonPresence | |
| NK1-5.6 | Area/City Code | 406 | Presence-Content Indifferent |
| NK1-5.7 | Local Number | 5555835 | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | Value-Profile Fixed |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | 5645 | Presence-Content Indifferent |
| ORC-2.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-2.3 | Universal ID | Indifferent | |
| ORC-2.4 | Universal ID Type | Indifferent | |
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 22515 | Presence-Content Indifferent |
| ORC-3.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-3.3 | Universal ID | Indifferent | |
| ORC-3.4 | Universal ID Type | Indifferent | |
| ORC-10 | Entered By | ||
| ORC-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| ORC-10.2 | Family Name | ||
| ORC-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| ORC-10.2.2 | Own Surname Prefix | ||
| ORC-10.2.3 | Own Surname | ||
| ORC-10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-10.2.5 | Surname From Partner/Spouse | ||
| ORC-10.3 | Given Name | Lily | Presence-Content Indifferent |
| ORC-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| ORC-10.9 | Assigning Authority | ||
| ORC-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-10.9.2 | Universal ID | ||
| ORC-10.9.3 | Universal ID Type | ||
| ORC-10.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-10.12 | Check Digit Scheme | Indifferent | |
| ORC-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| ORC-12 | Ordering Provider | ||
| ORC-12.1 | ID Number | 654 | Presence-Content Indifferent |
| ORC-12.2 | Family Name | ||
| ORC-12.2.1 | Surname | Thomas | Presence-Content Indifferent |
| ORC-12.2.2 | Own Surname Prefix | ||
| ORC-12.2.3 | Own Surname | ||
| ORC-12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-12.2.5 | Surname From Partner/Spouse | ||
| ORC-12.3 | Given Name | Wilma | Presence-Content Indifferent |
| ORC-12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | Presence-Content Indifferent |
| ORC-12.9 | Assigning Authority | ||
| ORC-12.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-12.9.2 | Universal ID | ||
| ORC-12.9.3 | Universal ID Type | ||
| ORC-12.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-12.12 | Check Digit Scheme | Indifferent | |
| ORC-12.13 | Identifier Type Code | MD | Presence-Content Indifferent |
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | wcEHR | Presence-Content Indifferent |
| ORC-17.2 | Text | West Clinic | Presence-Content Indifferent |
| ORC-17.3 | Name of Coding System | HL70362 | Value-Profile Fixed |
| ORC-17.5 | Alternate Text | Indifferent | |
| ORC-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | Value-Profile Fixed |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | 5027 | Presence-Content Indifferent |
| ORC-2.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-2.3 | Universal ID | Indifferent | |
| ORC-2.4 | Universal ID Type | Indifferent | |
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 12128 | Presence-Content Indifferent |
| ORC-3.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-3.3 | Universal ID | Indifferent | |
| ORC-3.4 | Universal ID Type | Indifferent | |
| ORC-10 | Entered By | ||
| ORC-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| ORC-10.2 | Family Name | ||
| ORC-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| ORC-10.2.2 | Own Surname Prefix | ||
| ORC-10.2.3 | Own Surname | ||
| ORC-10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-10.2.5 | Surname From Partner/Spouse | ||
| ORC-10.3 | Given Name | Lily | Presence-Content Indifferent |
| ORC-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| ORC-10.9 | Assigning Authority | ||
| ORC-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-10.9.2 | Universal ID | ||
| ORC-10.9.3 | Universal ID Type | ||
| ORC-10.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-10.12 | Check Digit Scheme | Indifferent | |
| ORC-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| ORC-12 | Ordering Provider | ||
| ORC-12.1 | ID Number | 654 | Presence-Content Indifferent |
| ORC-12.2 | Family Name | ||
| ORC-12.2.1 | Surname | Thomas | Presence-Content Indifferent |
| ORC-12.2.2 | Own Surname Prefix | ||
| ORC-12.2.3 | Own Surname | ||
| ORC-12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-12.2.5 | Surname From Partner/Spouse | ||
| ORC-12.3 | Given Name | Wilma | Presence-Content Indifferent |
| ORC-12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | Presence-Content Indifferent |
| ORC-12.9 | Assigning Authority | ||
| ORC-12.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-12.9.2 | Universal ID | ||
| ORC-12.9.3 | Universal ID Type | ||
| ORC-12.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-12.12 | Check Digit Scheme | Indifferent | |
| ORC-12.13 | Identifier Type Code | MD | Presence-Content Indifferent |
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | wcEHR | Presence-Content Indifferent |
| ORC-17.2 | Text | West Clinic | Presence-Content Indifferent |
| ORC-17.3 | Name of Coding System | HL70362 | Value-Profile Fixed |
| ORC-17.5 | Alternate Text | Indifferent | |
| ORC-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | Value-Profile Fixed |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | 7239 | Presence-Content Indifferent |
| ORC-2.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-2.3 | Universal ID | Indifferent | |
| ORC-2.4 | Universal ID Type | Indifferent | |
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 50588 | Presence-Content Indifferent |
| ORC-3.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-3.3 | Universal ID | Indifferent | |
| ORC-3.4 | Universal ID Type | Indifferent | |
| ORC-10 | Entered By | ||
| ORC-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| ORC-10.2 | Family Name | ||
| ORC-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| ORC-10.2.2 | Own Surname Prefix | ||
| ORC-10.2.3 | Own Surname | ||
| ORC-10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-10.2.5 | Surname From Partner/Spouse | ||
| ORC-10.3 | Given Name | Lily | Presence-Content Indifferent |
| ORC-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| ORC-10.9 | Assigning Authority | ||
| ORC-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-10.9.2 | Universal ID | ||
| ORC-10.9.3 | Universal ID Type | ||
| ORC-10.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-10.12 | Check Digit Scheme | Indifferent | |
| ORC-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| ORC-12 | Ordering Provider | ||
| ORC-12.1 | ID Number | 654 | Presence-Content Indifferent |
| ORC-12.2 | Family Name | ||
| ORC-12.2.1 | Surname | Thomas | Presence-Content Indifferent |
| ORC-12.2.2 | Own Surname Prefix | ||
| ORC-12.2.3 | Own Surname | ||
| ORC-12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-12.2.5 | Surname From Partner/Spouse | ||
| ORC-12.3 | Given Name | Wilma | Presence-Content Indifferent |
| ORC-12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | Presence-Content Indifferent |
| ORC-12.9 | Assigning Authority | ||
| ORC-12.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-12.9.2 | Universal ID | ||
| ORC-12.9.3 | Universal ID Type | ||
| ORC-12.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-12.12 | Check Digit Scheme | Indifferent | |
| ORC-12.13 | Identifier Type Code | MD | Presence-Content Indifferent |
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | wcEHR | Presence-Content Indifferent |
| ORC-17.2 | Text | West Clinic | Presence-Content Indifferent |
| ORC-17.3 | Name of Coding System | HL70362 | Value-Profile Fixed |
| ORC-17.5 | Alternate Text | Indifferent | |
| ORC-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | Value-Profile Fixed |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | Indifferent | |
| ORC-2.2 | Namespace ID | Indifferent | |
| ORC-2.3 | Universal ID | Indifferent | |
| ORC-2.4 | Universal ID Type | Indifferent | |
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 9999 | Presence-Content Indifferent |
| ORC-3.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-3.3 | Universal ID | Indifferent | |
| ORC-3.4 | Universal ID Type | Indifferent | |
| ORC-10 | Entered By | ||
| ORC-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| ORC-10.2 | Family Name | ||
| ORC-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| ORC-10.2.2 | Own Surname Prefix | ||
| ORC-10.2.3 | Own Surname | ||
| ORC-10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-10.2.5 | Surname From Partner/Spouse | ||
| ORC-10.3 | Given Name | Lily | Presence-Content Indifferent |
| ORC-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| ORC-10.9 | Assigning Authority | ||
| ORC-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-10.9.2 | Universal ID | ||
| ORC-10.9.3 | Universal ID Type | ||
| ORC-10.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-10.12 | Check Digit Scheme | Indifferent | |
| ORC-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| ORC-12 | Ordering Provider | ||
| ORC-12.1 | ID Number | Indifferent | |
| ORC-12.2 | Family Name | ||
| ORC-12.2.1 | Surname | Indifferent | |
| ORC-12.2.2 | Own Surname Prefix | ||
| ORC-12.2.3 | Own Surname | ||
| ORC-12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-12.2.5 | Surname From Partner/Spouse | ||
| ORC-12.3 | Given Name | Indifferent | |
| ORC-12.4 | Second and Further Given Names or Initials Thereof | Indifferent | |
| ORC-12.9 | Assigning Authority | ||
| ORC-12.9.1 | Namespace ID | Indifferent | |
| ORC-12.9.2 | Universal ID | Indifferent | |
| ORC-12.9.3 | Universal ID Type | Indifferent | |
| ORC-12.10 | Name Type Code | Indifferent | |
| ORC-12.12 | Check Digit Scheme | Indifferent | |
| ORC-12.13 | Identifier Type Code | Indifferent | |
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | wcEHR | Presence-Content Indifferent |
| ORC-17.2 | Text | West Clinic | Presence-Content Indifferent |
| ORC-17.3 | Name of Coding System | HL70362 | Value-Profile Fixed |
| ORC-17.5 | Alternate Text | Indifferent | |
| ORC-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | Value-Profile Fixed |
| RXA-2 | Administration Sub-ID Counter | 1 | Value-Profile Fixed |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20150624 | Presence-Content Indifferent |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 58160-0806-01 | Value-Test Case Fixed |
| RXA-5.2 | Text | HIBERIX | Presence-Content Indifferent |
| RXA-5.3 | Name of Coding System | NDC | Value-Test Case Fixed |
| RXA-5.5 | Alternate Text | Indifferent | |
| RXA-5.6 | Name of Alternate Coding System | Indifferent | |
| RXA-6 | Administered Amount | 0.5 | Value-Test Case Fixed |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | mL | Value-Test Case Fixed |
| RXA-7.2 | Text | mL | Presence-Content Indifferent |
| RXA-7.3 | Name of Coding System | UCUM | Value-Test Case Fixed |
| RXA-7.5 | Alternate Text | Indifferent | |
| RXA-7.6 | Name of Alternate Coding System | Indifferent | |
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 00 | Value-Test Case Fixed |
| RXA-9.2 | Text | New Record | Presence-Content Indifferent |
| RXA-9.3 | Name of Coding System | NIP001 | Value-Profile Fixed |
| RXA-9.5 | Alternate Text | Indifferent | |
| RXA-9.6 | Name of Alternate Coding System | Indifferent | |
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Lily | Presence-Content Indifferent |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | L | Presence-Content Indifferent |
| RXA-10.12 | Check Digit Scheme | Indifferent | |
| RXA-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-11.4.2 | Universal ID | Indifferent | |
| RXA-11.4.3 | Universal ID Type | Indifferent | |
| RXA-15 | Substance Lot Number | 328734 | Presence-Content Indifferent |
| RXA-16 | Substance Expiration Date | ||
| RXA-16.1 | Time | 20150923 | Presence-Content Indifferent |
| RXA-17 | Substance Manufacturer Name | ||
| RXA-17.1 | Identifier | SKB | Presence-Content Indifferent |
| RXA-17.2 | Text | GlaxoSmithKline | Presence-Content Indifferent |
| RXA-17.3 | Name of Coding System | MVX | Value-Test Case Fixed |
| RXA-17.5 | Alternate Text | Indifferent | |
| RXA-17.6 | Name of Alternate Coding System | Indifferent | |
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | Indifferent | |
| RXA-18.2 | Text | Indifferent | |
| RXA-18.3 | Name of Coding System | Indifferent | |
| RXA-18.5 | Alternate Text | Indifferent | |
| RXA-18.6 | Name of Alternate Coding System | Indifferent | |
| RXA-20 | Completion Status | CP | Value-Test Case Fixed |
| RXA-21 | Action Code - RXA | A | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | Value-Profile Fixed |
| RXA-2 | Administration Sub-ID Counter | 1 | Value-Profile Fixed |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20150624 | Presence-Content Indifferent |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 00006-4095-01 | Value-Test Case Fixed |
| RXA-5.2 | Text | VAQTA | Presence-Content Indifferent |
| RXA-5.3 | Name of Coding System | NDC | Value-Test Case Fixed |
| RXA-5.5 | Alternate Text | Indifferent | |
| RXA-5.6 | Name of Alternate Coding System | Indifferent | |
| RXA-6 | Administered Amount | 0.5 | Value-Test Case Fixed |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | mL | Value-Test Case Fixed |
| RXA-7.2 | Text | mL | Presence-Content Indifferent |
| RXA-7.3 | Name of Coding System | UCUM | Value-Test Case Fixed |
| RXA-7.5 | Alternate Text | Indifferent | |
| RXA-7.6 | Name of Alternate Coding System | Indifferent | |
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 00 | Value-Test Case Fixed |
| RXA-9.2 | Text | New Record | Presence-Content Indifferent |
| RXA-9.3 | Name of Coding System | NIP001 | Value-Profile Fixed |
| RXA-9.5 | Alternate Text | Indifferent | |
| RXA-9.6 | Name of Alternate Coding System | Indifferent | |
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Lily | Presence-Content Indifferent |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | L | Presence-Content Indifferent |
| RXA-10.12 | Check Digit Scheme | Indifferent | |
| RXA-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-11.4.2 | Universal ID | Indifferent | |
| RXA-11.4.3 | Universal ID Type | Indifferent | |
| RXA-15 | Substance Lot Number | 208940 | Presence-Content Indifferent |
| RXA-16 | Substance Expiration Date | ||
| RXA-16.1 | Time | 20160120 | Presence-Content Indifferent |
| RXA-17 | Substance Manufacturer Name | ||
| RXA-17.1 | Identifier | MSD | Presence-Content Indifferent |
| RXA-17.2 | Text | Merck and Co., Inc. | Presence-Content Indifferent |
| RXA-17.3 | Name of Coding System | MVX | Value-Test Case Fixed |
| RXA-17.5 | Alternate Text | Indifferent | |
| RXA-17.6 | Name of Alternate Coding System | Indifferent | |
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | Indifferent | |
| RXA-18.2 | Text | Indifferent | |
| RXA-18.3 | Name of Coding System | Indifferent | |
| RXA-18.5 | Alternate Text | Indifferent | |
| RXA-18.6 | Name of Alternate Coding System | Indifferent | |
| RXA-20 | Completion Status | CP | Value-Test Case Fixed |
| RXA-21 | Action Code - RXA | A | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | Value-Profile Fixed |
| RXA-2 | Administration Sub-ID Counter | 1 | Value-Profile Fixed |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20150624 | Presence-Content Indifferent |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 00006-4681-01 | Value-Test Case Fixed |
| RXA-5.2 | Text | M-M-R II | Presence-Content Indifferent |
| RXA-5.3 | Name of Coding System | NDC | Value-Test Case Fixed |
| RXA-5.5 | Alternate Text | Indifferent | |
| RXA-5.6 | Name of Alternate Coding System | Indifferent | |
| RXA-6 | Administered Amount | 0.5 | Value-Test Case Fixed |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | mL | Value-Test Case Fixed |
| RXA-7.2 | Text | mL | Presence-Content Indifferent |
| RXA-7.3 | Name of Coding System | UCUM | Value-Test Case Fixed |
| RXA-7.5 | Alternate Text | Indifferent | |
| RXA-7.6 | Name of Alternate Coding System | Indifferent | |
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 00 | Value-Test Case Fixed |
| RXA-9.2 | Text | New Record | Presence-Content Indifferent |
| RXA-9.3 | Name of Coding System | NIP001 | Value-Profile Fixed |
| RXA-9.5 | Alternate Text | Indifferent | |
| RXA-9.6 | Name of Alternate Coding System | Indifferent | |
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Lily | Presence-Content Indifferent |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | L | Presence-Content Indifferent |
| RXA-10.12 | Check Digit Scheme | Indifferent | |
| RXA-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-11.4.2 | Universal ID | Indifferent | |
| RXA-11.4.3 | Universal ID Type | Indifferent | |
| RXA-15 | Substance Lot Number | 134301 | Presence-Content Indifferent |
| RXA-16 | Substance Expiration Date | ||
| RXA-16.1 | Time | 20151028 | Presence-Content Indifferent |
| RXA-17 | Substance Manufacturer Name | ||
| RXA-17.1 | Identifier | MSD | Presence-Content Indifferent |
| RXA-17.2 | Text | Merck and Co., Inc. | Presence-Content Indifferent |
| RXA-17.3 | Name of Coding System | MVX | Value-Test Case Fixed |
| RXA-17.5 | Alternate Text | Indifferent | |
| RXA-17.6 | Name of Alternate Coding System | Indifferent | |
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | Indifferent | |
| RXA-18.2 | Text | Indifferent | |
| RXA-18.3 | Name of Coding System | Indifferent | |
| RXA-18.5 | Alternate Text | Indifferent | |
| RXA-18.6 | Name of Alternate Coding System | Indifferent | |
| RXA-20 | Completion Status | CP | Value-Test Case Fixed |
| RXA-21 | Action Code - RXA | A | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | Value-Profile Fixed |
| RXA-2 | Administration Sub-ID Counter | 1 | Value-Profile Fixed |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20150624 | Presence-Content Indifferent |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 21 | Value-Test Case Fixed |
| RXA-5.2 | Text | varicella | Presence-Content Indifferent |
| RXA-5.3 | Name of Coding System | CVX | Value-Test Case Fixed |
| RXA-5.5 | Alternate Text | Indifferent | |
| RXA-5.6 | Name of Alternate Coding System | Indifferent | |
| RXA-6 | Administered Amount | 999 | Value-Test Case Fixed |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | NonPresence | |
| RXA-7.2 | Text | NonPresence | |
| RXA-7.3 | Name of Coding System | NonPresence | |
| RXA-7.5 | Alternate Text | NonPresence | |
| RXA-7.6 | Name of Alternate Coding System | NonPresence | |
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | Indifferent | |
| RXA-9.2 | Text | Indifferent | |
| RXA-9.3 | Name of Coding System | Indifferent | |
| RXA-9.5 | Alternate Text | Indifferent | |
| RXA-9.6 | Name of Alternate Coding System | Indifferent | |
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | Indifferent | |
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Indifferent | |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Indifferent | |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | Indifferent | |
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | Indifferent | |
| RXA-10.9.2 | Universal ID | Indifferent | |
| RXA-10.9.3 | Universal ID Type | Indifferent | |
| RXA-10.10 | Name Type Code | Indifferent | |
| RXA-10.12 | Check Digit Scheme | Indifferent | |
| RXA-10.13 | Identifier Type Code | Indifferent | |
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | Presence-Content Indifferent | |
| RXA-11.4.2 | Universal ID | Indifferent | |
| RXA-11.4.3 | Universal ID Type | Indifferent | |
| RXA-15 | Substance Lot Number | Indifferent | |
| RXA-16 | Substance Expiration Date | ||
| RXA-16.1 | Time | Indifferent | |
| RXA-17 | Substance Manufacturer Name | ||
| RXA-17.1 | Identifier | Indifferent | |
| RXA-17.2 | Text | Indifferent | |
| RXA-17.3 | Name of Coding System | Indifferent | |
| RXA-17.5 | Alternate Text | Indifferent | |
| RXA-17.6 | Name of Alternate Coding System | Indifferent | |
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | 00 | Value-Test Case Fixed |
| RXA-18.2 | Text | Parental decision | Presence-Content Indifferent |
| RXA-18.3 | Name of Coding System | NIP002 | Value-Profile Fixed |
| RXA-18.5 | Alternate Text | Indifferent | |
| RXA-18.6 | Name of Alternate Coding System | Indifferent | |
| RXA-20 | Completion Status | RE | Value-Test Case Fixed |
| RXA-21 | Action Code - RXA | A | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR-1 | Route | ||
| RXR-1.1 | Identifier | C28161 | Presence-Content Indifferent |
| RXR-1.2 | Text | Intramuscular | Presence-Content Indifferent |
| RXR-1.3 | Name of Coding System | NCIT | Value-Profile Fixed |
| RXR-1.5 | Alternate Text | Indifferent | |
| RXR-1.6 | Name of Alternate Coding System | Indifferent | |
| RXR-2 | Administration Site | ||
| RXR-2.1 | Identifier | RT | Presence-Content Indifferent |
| RXR-2.2 | Text | Right Thigh | Presence-Content Indifferent |
| RXR-2.3 | Name of Coding System | HL70163 | Value-Profile Fixed |
| RXR-2.5 | Alternate Text | Indifferent | |
| RXR-2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR-1 | Route | ||
| RXR-1.1 | Identifier | C28161 | Presence-Content Indifferent |
| RXR-1.2 | Text | Intramuscular | Presence-Content Indifferent |
| RXR-1.3 | Name of Coding System | NCIT | Value-Profile Fixed |
| RXR-1.5 | Alternate Text | Indifferent | |
| RXR-1.6 | Name of Alternate Coding System | Indifferent | |
| RXR-2 | Administration Site | ||
| RXR-2.1 | Identifier | RT | Presence-Content Indifferent |
| RXR-2.2 | Text | Right Thigh | Presence-Content Indifferent |
| RXR-2.3 | Name of Coding System | HL70163 | Value-Profile Fixed |
| RXR-2.5 | Alternate Text | Indifferent | |
| RXR-2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR-1 | Route | ||
| RXR-1.1 | Identifier | C38299 | Presence-Content Indifferent |
| RXR-1.2 | Text | Subcutaneous | Presence-Content Indifferent |
| RXR-1.3 | Name of Coding System | NCIT | Value-Profile Fixed |
| RXR-1.5 | Alternate Text | Indifferent | |
| RXR-1.6 | Name of Alternate Coding System | Indifferent | |
| RXR-2 | Administration Site | ||
| RXR-2.1 | Identifier | LT | Presence-Content Indifferent |
| RXR-2.2 | Text | Left Thigh | Presence-Content Indifferent |
| RXR-2.3 | Name of Coding System | HL70163 | Value-Profile Fixed |
| RXR-2.5 | Alternate Text | Indifferent | |
| RXR-2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 1 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30963-3 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Source | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 1 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-5.1 | Identifier | PHC70 | |
| OBX-5.2 | Text | Private | |
| OBX-5.3 | Name of Coding System | CDCPHINVS | |
| OBX-5.5 | Alternate Text | ||
| OBX-5.6 | Name of Alternate Coding System | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 2 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 64994-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Program Eligibility | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 2 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-5.1 | Identifier | V01 | |
| OBX-5.2 | Text | Not VFC Eligible | |
| OBX-5.3 | Name of Coding System | HL70064 | |
| OBX-5.5 | Alternate Text | ||
| OBX-5.6 | Name of Alternate Coding System | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | VXC40 | Value-Test Case Fixed |
| OBX-17.2 | Text | per immunization | Presence-Content Indifferent |
| OBX-17.3 | Name of Coding System | CDCPHINVS | Value-Profile Fixed |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 3 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 69764-9 | Value-Test Case Fixed |
| OBX-3.2 | Text | Document Type | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-5.1 | Identifier | 253088698300026411141022 | |
| OBX-5.2 | Text | Multiple Vaccines VIS | |
| OBX-5.3 | Name of Coding System | cdcgs1vis | |
| OBX-5.5 | Alternate Text | ||
| OBX-5.6 | Name of Alternate Coding System | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 4 | Value-Profile Fixed |
| OBX-2 | Value Type | DT | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 29769-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Date Vis Presented | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | 20150624 | Presence-Content Indifferent |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 1 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30963-3 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Source | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 1 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-5.1 | Identifier | PHC70 | |
| OBX-5.2 | Text | Private | |
| OBX-5.3 | Name of Coding System | CDCPHINVS | |
| OBX-5.5 | Alternate Text | ||
| OBX-5.6 | Name of Alternate Coding System | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 2 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 64994-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Program Eligibility | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 2 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-5.1 | Identifier | V01 | |
| OBX-5.2 | Text | Not VFC Eligible | |
| OBX-5.3 | Name of Coding System | HL70064 | |
| OBX-5.5 | Alternate Text | ||
| OBX-5.6 | Name of Alternate Coding System | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | VXC40 | Value-Test Case Fixed |
| OBX-17.2 | Text | per immunization | Presence-Content Indifferent |
| OBX-17.3 | Name of Coding System | CDCPHINVS | Value-Profile Fixed |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 3 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 69764-9 | Value-Test Case Fixed |
| OBX-3.2 | Text | Document Type | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-5.1 | Identifier | 253088698300004211111025 | |
| OBX-5.2 | Text | Hepatitis A VIS | |
| OBX-5.3 | Name of Coding System | cdcgs1vis | |
| OBX-5.5 | Alternate Text | ||
| OBX-5.6 | Name of Alternate Coding System | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 4 | Value-Profile Fixed |
| OBX-2 | Value Type | DT | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 29769-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Date Vis Presented | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | 20150624 | Presence-Content Indifferent |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 1 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30963-3 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Source | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 1 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-5.1 | Identifier | PHC70 | |
| OBX-5.2 | Text | Private | |
| OBX-5.3 | Name of Coding System | CDCPHINVS | |
| OBX-5.5 | Alternate Text | ||
| OBX-5.6 | Name of Alternate Coding System | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 2 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 64994-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Program Eligibility | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 2 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-5.1 | Identifier | V01 | |
| OBX-5.2 | Text | Not VFC Eligible | |
| OBX-5.3 | Name of Coding System | HL70064 | |
| OBX-5.5 | Alternate Text | ||
| OBX-5.6 | Name of Alternate Coding System | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | VXC40 | Value-Test Case Fixed |
| OBX-17.2 | Text | per immunization | Presence-Content Indifferent |
| OBX-17.3 | Name of Coding System | CDCPHINVS | Value-Profile Fixed |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 3 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 69764-9 | Value-Test Case Fixed |
| OBX-3.2 | Text | Document Type | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-5.1 | Identifier | 253088698300012711120420 | |
| OBX-5.2 | Text | Measles/Mumps/Rubella VIS | |
| OBX-5.3 | Name of Coding System | cdcgs1vis | |
| OBX-5.5 | Alternate Text | ||
| OBX-5.6 | Name of Alternate Coding System | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 4 | Value-Profile Fixed |
| OBX-2 | Value Type | DT | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 29769-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Date Vis Presented | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | 20150624 | Presence-Content Indifferent |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Element | Data |
|---|---|
| Patient Name | Tyler Owen Banks |
| Mother's Maiden Name | |
| ID Number | 8891 |
| Date/Time of Birth | 06/02/2014 |
| Administrative Sex | Male |
| Patient Address | 924 Sycamore Lane Bozeman MT 59715 USA |
| Local Number | (406)555-5835 |
| Race | White |
| Ethnic Group | Not Hispanic or Latino |
| Multiple Birth Indicator | Y |
| Birth Order | 2 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 06/02/2004 |
| Publicity Code | Reminder/recall - any method |
| Publicity Code Effective Date | 06/24/2015 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 06/24/2015 |
| Element | Data |
|---|---|
| Name | Karl Leonard Banks |
| Relationship | Father |
| Address | 924 Sycamore Lane Bozeman MT 59715 USA |
| Phone Number | (406)555-5835 |
| Element | Data |
|---|---|
| Administered Code | HIBERIX |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 328734 |
| Substance Expiration Date | 09/23/2015 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Right Thigh |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Private |
| Vaccine Funding Program Eligibility | Not VFC Eligible |
| Document Type | Multiple Vaccines VIS |
| Date Vis Presented | 06/24/2015 |
| Element | Data |
|---|---|
| Administered Code | VAQTA |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 208940 |
| Substance Expiration Date | 01/20/2016 |
| Substance Manufacturer Name | Merck and Co., Inc. |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Right Thigh |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Private |
| Vaccine Funding Program Eligibility | Not VFC Eligible |
| Document Type | Hepatitis A VIS |
| Date Vis Presented | 06/24/2015 |
| Element | Data |
|---|---|
| Administered Code | M-M-R II |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 134301 |
| Substance Expiration Date | 10/28/2015 |
| Substance Manufacturer Name | Merck and Co., Inc. |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Subcutaneous |
| Administration Site | Left Thigh |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Private |
| Vaccine Funding Program Eligibility | Not VFC Eligible |
| Document Type | Measles/Mumps/Rubella VIS |
| Date Vis Presented | 06/24/2015 |
| Element | Data |
|---|---|
| Administered Code | varicella |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | Parental decision |
| Completion Status | RE |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By |
| Element | Data |
|---|---|
| Patient Name | Tyler Owen Banks |
| Mother's Maiden Name | |
| ID Number | 8891 |
| Date/Time of Birth | 06/02/2014 |
| Administrative Sex | Male |
| Patient Address | 924 Sycamore Lane Bozeman MT 59715 USA |
| Local Number | (406)555-5835 |
| Race | White |
| Ethnic Group | Not Hispanic or Latino |
| Multiple Birth Indicator | Y |
| Birth Order | 2 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 06/02/2004 |
| Publicity Code | Reminder/recall - any method |
| Publicity Code Effective Date | 06/24/2015 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 06/24/2015 |
| Element | Data |
|---|---|
| Name | Karl Leonard Banks |
| Relationship | Father |
| Address | 924 Sycamore Lane Bozeman MT 59715 USA |
| Phone Number | (406)555-5835 |
| Element | Data |
|---|---|
| Administered Code | HIBERIX |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 328734 |
| Substance Expiration Date | 09/23/2015 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Right Thigh |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Private |
| Vaccine Funding Program Eligibility | Not VFC Eligible |
| Document Type | Multiple Vaccines VIS |
| Date Vis Presented | 06/24/2015 |
| Element | Data |
|---|---|
| Administered Code | VAQTA |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 208940 |
| Substance Expiration Date | 01/20/2016 |
| Substance Manufacturer Name | Merck and Co., Inc. |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Right Thigh |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Private |
| Vaccine Funding Program Eligibility | Not VFC Eligible |
| Document Type | Hepatitis A VIS |
| Date Vis Presented | 06/24/2015 |
| Element | Data |
|---|---|
| Administered Code | M-M-R II |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 134301 |
| Substance Expiration Date | 10/28/2015 |
| Substance Manufacturer Name | Merck and Co., Inc. |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Subcutaneous |
| Administration Site | Left Thigh |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Private |
| Vaccine Funding Program Eligibility | Not VFC Eligible |
| Document Type | Measles/Mumps/Rubella VIS |
| Date Vis Presented | 06/24/2015 |
| Element | Data |
|---|---|
| Administered Code | varicella |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | Parental decision |
| Completion Status | RE |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By |
| Description |
|---|
| The IIS returns a positive acknowledgement message indicating that no errors were found during the course of filing the message. |
| Comments |
|---|
| No Comments |
| Pre Condition |
|---|
| A VXU message is generated by the EHR. |
| Post Condition |
|---|
| No PostCondition |
| Test Objectives |
|---|
| Evaluation Criteria |
|---|
| The acknowledgement message is consumed by the system responsible for the content of the administration message without error. |
| Notes for Testers |
|---|
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | iisApp | Presence-Content Indifferent |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | IIS | Presence-Content Indifferent |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | wcApp | Presence-Content Indifferent |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150624093847.822-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | ACK | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | ACK | Value-Profile Fixed |
| MSH-10 | Message Control ID | 79946 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z23 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | IIS | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | Indifferent | |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | Indifferent | |
| MSH-22.10 | Organization Identifier | Indifferent | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | wcEHR | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | Indifferent | |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | Indifferent | |
| MSH-23.10 | Organization Identifier | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA-1 | Acknowledgment Code | AA | Value-Test Case Fixed |
| MSA-2 | Message Control ID | 18019 | Presence-System Generated |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | iisApp | Presence-Content Indifferent |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | IIS | Presence-Content Indifferent |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | wcApp | Presence-Content Indifferent |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150624093847.822-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | ACK | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | ACK | Value-Profile Fixed |
| MSH-10 | Message Control ID | 79946 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z23 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | IIS | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | Indifferent | |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | Indifferent | |
| MSH-22.10 | Organization Identifier | Indifferent | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | wcEHR | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | Indifferent | |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | Indifferent | |
| MSH-23.10 | Organization Identifier | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA-1 | Acknowledgment Code | AA | Value-Test Case Fixed |
| MSA-2 | Message Control ID | 18019 | Presence-System Generated |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Return an Acknowledgement | |||||
|---|---|---|---|---|---|
| Test Case ID | IZ-AD-5_Refusal | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement (Pass/Fail) |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which NO Error is returned in the message.
The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.
| Return an Acknowledgement |
|---|
|
The receiving HIT system being tested shall process the Z23 ACK message correctly; a positive notification indicating that the ACK message was processed correctly need not be made visible in the system. |
| Description |
|---|
| A child is seen at a clinic. A previously documented vaccination is updated to correct inaccurate information.. |
| Comments |
|---|
| No Comments |
| Pre Condition |
|---|
| The IZ-AD-5_Refusal test case has been successfully completed. |
| Post Condition |
|---|
| No PostCondition |
| Test Objectives |
|---|
| This test case asses the ability of the EHR to create an update message for a previously sent administration. |
| Evaluation Criteria |
|---|
| Notes for Testers |
|---|
| No Note |
| Description |
|---|
| After document vaccinations for Tyler Owen Banks the clinician, Lily Jackson (ID 456) recognizes that an error was made during data entry for the Hepatitis A vaccine. The Lot Number was entered incorrectly. She updates the data in the EHR and transmits it to the IIS. |
| Comments |
|---|
| No Comments |
| Pre Condition |
|---|
| The IZ-AD-5.1_Send_V04_Z22 test step has been successfully completed. |
| Post Condition |
|---|
| No PostCondition |
| Test Objectives |
|---|
| Support for sending an update request. |
| Evaluation Criteria |
|---|
| Message Validation Report. |
| Notes for Testers |
|---|
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | wcApp | Presence-Content Indifferent |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | iisApp | Presence-Content Indifferent |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | IIS | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150624093847.808-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | VXU | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | VXU_V04 | Value-Profile Fixed |
| MSH-10 | Message Control ID | 18019 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | ER | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | AL | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z22 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | wcEHR | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | Indifferent | |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | Indifferent | |
| MSH-22.10 | Organization Identifier | Indifferent | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | IIS | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | Indifferent | |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | Indifferent | |
| MSH-23.10 | Organization Identifier | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID-1 | Set ID - PID | 1 | Value-Profile Fixed |
| PID-3 | Patient Identifier List | ||
| PID-3.1 | ID Number | 8891 | Presence-Content Indifferent |
| PID-3.3 | Check Digit Scheme | Indifferent | |
| PID-3.4 | Assigning Authority | ||
| PID-3.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| PID-3.4.2 | Universal ID | Indifferent | |
| PID-3.4.3 | Universal ID Type | Indifferent | |
| PID-3.5 | Identifier Type Code | MR | Presence-Content Indifferent |
| PID-5 | Patient Name | ||
| PID-5.1 | Family Name | ||
| PID-5.1.1 | Surname | Banks | Presence-Content Indifferent |
| PID-5.1.2 | Own Surname Prefix | ||
| PID-5.1.3 | Own Surname | ||
| PID-5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-5.1.5 | Surname From Partner/Spouse | ||
| PID-5.2 | Given Name | Tyler | Presence-Content Indifferent |
| PID-5.3 | Second and Further Given Names or Initials Thereof | Owen | Presence-Content Indifferent |
| PID-5.7 | Name Type Code | L | Presence-Content Indifferent |
| PID-6 | Mother's Maiden Name | ||
| PID-6.1 | Family Name | ||
| PID-6.1.1 | Surname | Indifferent | |
| PID-6.1.2 | Own Surname Prefix | ||
| PID-6.1.3 | Own Surname | ||
| PID-6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-6.1.5 | Surname From Partner/Spouse | ||
| PID-6.7 | Name Type Code | Indifferent | |
| PID-7 | Date/Time of Birth | ||
| PID-7.1 | Time | 20140602 | Presence-Content Indifferent |
| PID-8 | Administrative Sex | M | Presence-Content Indifferent |
| PID-10 | Race | ||
| PID-10.1 | Identifier | 2106-3 | Presence-Content Indifferent |
| PID-10.2 | Text | White | Presence-Content Indifferent |
| PID-10.3 | Name of Coding System | CDCREC | Value-Profile Fixed |
| PID-10.5 | Alternate Text | Indifferent | |
| PID-10.6 | Name of Alternate Coding System | Indifferent | |
| PID-11 | Patient Address | ||
| PID-11.1 | Street Address | ||
| PID-11.1.1 | Street or Mailing Address | 924 Sycamore Lane | Presence-Content Indifferent |
| PID-11.1.2 | Street Name | ||
| PID-11.1.3 | Dwelling Number | ||
| PID-11.2 | Other Designation | Indifferent | |
| PID-11.3 | City | Bozeman | Presence-Content Indifferent |
| PID-11.4 | State or Province | MT | Presence-Content Indifferent |
| PID-11.5 | Zip or Postal Code | 59715 | Presence-Content Indifferent |
| PID-11.6 | Country | USA | Presence-Content Indifferent |
| PID-11.7 | Address Type | P | Presence-Content Indifferent |
| PID-13 | Phone Number - Home | ||
| PID-13.2 | Telecommunication Use Code | PRN | Presence-Content Indifferent |
| PID-13.3 | Telecommunication Equipment Type | PH | Value-Test Case Fixed |
| PID-13.4 | Email Address | NonPresence | |
| PID-13.6 | Area/City Code | 406 | Presence-Content Indifferent |
| PID-13.7 | Local Number | 5555835 | Presence-Content Indifferent |
| PID-22 | Ethnic Group | ||
| PID-22.1 | Identifier | 2186-5 | Presence-Content Indifferent |
| PID-22.2 | Text | Not Hispanic or Latino | Presence-Content Indifferent |
| PID-22.3 | Name of Coding System | CDCREC | Value-Profile Fixed |
| PID-22.5 | Alternate Text | Indifferent | |
| PID-22.6 | Name of Alternate Coding System | Indifferent | |
| PID-24 | Multiple Birth Indicator | Y | Value-Test Case Fixed |
| PID-25 | Birth Order | 2 | Value-Test Case Fixed |
| PID-29 | Patient Death Date and Time | ||
| PID-29.1 | Time | Indifferent | |
| PID-30 | Patient Death Indicator | N | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1-11 | Publicity Code | ||
| PD1-11.1 | Identifier | 02 | Presence-Content Indifferent |
| PD1-11.2 | Text | Reminder/recall - any method | Presence-Content Indifferent |
| PD1-11.3 | Name of Coding System | HL70215 | Value-Profile Fixed |
| PD1-11.5 | Alternate Text | Indifferent | |
| PD1-11.6 | Name of Alternate Coding System | Indifferent | |
| PD1-12 | Protection Indicator | Y | Value-Test Case Fixed |
| PD1-13 | Protection Indicator Effective Date | 20150624 | Presence-Content Indifferent |
| PD1-16 | Immunization Registry Status | A | Presence-Content Indifferent |
| PD1-17 | Immunization Registry Status Effective Date | 20040602 | Presence-Content Indifferent |
| PD1-18 | Publicity Code Effective Date | 20150624 | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| NK1-1 | Set ID - NK1 | 1 | Value-Profile Fixed |
| NK1-2 | Name | ||
| NK1-2.1 | Family Name | ||
| NK1-2.1.1 | Surname | Banks | Presence-Content Indifferent |
| NK1-2.1.2 | Own Surname Prefix | ||
| NK1-2.1.3 | Own Surname | ||
| NK1-2.1.4 | Surname Prefix From Partner/Spouse | ||
| NK1-2.1.5 | Surname From Partner/Spouse | ||
| NK1-2.2 | Given Name | Karl | Presence-Content Indifferent |
| NK1-2.3 | Second and Further Given Names or Initials Thereof | Leonard | Presence-Content Indifferent |
| NK1-2.7 | Name Type Code | L | Presence-Content Indifferent |
| NK1-3 | Relationship | ||
| NK1-3.1 | Identifier | FTH | Presence-Content Indifferent |
| NK1-3.2 | Text | Father | Presence-Content Indifferent |
| NK1-3.3 | Name of Coding System | HL70063 | Value-Profile Fixed |
| NK1-3.5 | Alternate Text | Indifferent | |
| NK1-3.6 | Name of Alternate Coding System | Indifferent | |
| NK1-4 | Address | ||
| NK1-4.1 | Street Address | ||
| NK1-4.1.1 | Street or Mailing Address | 924 Sycamore Lane | Presence-Content Indifferent |
| NK1-4.1.2 | Street Name | ||
| NK1-4.1.3 | Dwelling Number | ||
| NK1-4.2 | Other Designation | Indifferent | |
| NK1-4.3 | City | Bozeman | Presence-Content Indifferent |
| NK1-4.4 | State or Province | MT | Presence-Content Indifferent |
| NK1-4.5 | Zip or Postal Code | 59715 | Presence-Content Indifferent |
| NK1-4.6 | Country | USA | Presence-Content Indifferent |
| NK1-4.7 | Address Type | P | Presence-Content Indifferent |
| NK1-5 | Phone Number | ||
| NK1-5.2 | Telecommunication Use Code | PRN | Presence-Content Indifferent |
| NK1-5.3 | Telecommunication Equipment Type | PH | Value-Test Case Fixed |
| NK1-5.4 | Email Address | NonPresence | |
| NK1-5.6 | Area/City Code | 406 | Presence-Content Indifferent |
| NK1-5.7 | Local Number | 5555835 | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | Value-Profile Fixed |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | 5027 | Presence-Content Indifferent |
| ORC-2.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-2.3 | Universal ID | Indifferent | |
| ORC-2.4 | Universal ID Type | Indifferent | |
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 12128 | Presence-Content Indifferent |
| ORC-3.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-3.3 | Universal ID | Indifferent | |
| ORC-3.4 | Universal ID Type | Indifferent | |
| ORC-10 | Entered By | ||
| ORC-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| ORC-10.2 | Family Name | ||
| ORC-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| ORC-10.2.2 | Own Surname Prefix | ||
| ORC-10.2.3 | Own Surname | ||
| ORC-10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-10.2.5 | Surname From Partner/Spouse | ||
| ORC-10.3 | Given Name | Lily | Presence-Content Indifferent |
| ORC-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| ORC-10.9 | Assigning Authority | ||
| ORC-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-10.9.2 | Universal ID | ||
| ORC-10.9.3 | Universal ID Type | ||
| ORC-10.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-10.12 | Check Digit Scheme | Indifferent | |
| ORC-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| ORC-12 | Ordering Provider | ||
| ORC-12.1 | ID Number | 654 | Presence-Content Indifferent |
| ORC-12.2 | Family Name | ||
| ORC-12.2.1 | Surname | Thomas | Presence-Content Indifferent |
| ORC-12.2.2 | Own Surname Prefix | ||
| ORC-12.2.3 | Own Surname | ||
| ORC-12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-12.2.5 | Surname From Partner/Spouse | ||
| ORC-12.3 | Given Name | Wilma | Presence-Content Indifferent |
| ORC-12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | Presence-Content Indifferent |
| ORC-12.9 | Assigning Authority | ||
| ORC-12.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-12.9.2 | Universal ID | ||
| ORC-12.9.3 | Universal ID Type | ||
| ORC-12.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-12.12 | Check Digit Scheme | Indifferent | |
| ORC-12.13 | Identifier Type Code | MD | Presence-Content Indifferent |
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | wcEHR | Presence-Content Indifferent |
| ORC-17.2 | Text | West Clinic | Presence-Content Indifferent |
| ORC-17.3 | Name of Coding System | HL70362 | Value-Profile Fixed |
| ORC-17.5 | Alternate Text | Indifferent | |
| ORC-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | Value-Profile Fixed |
| RXA-2 | Administration Sub-ID Counter | 1 | Value-Profile Fixed |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20150624 | Presence-Content Indifferent |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 00006-4095-01 | Value-Test Case Fixed |
| RXA-5.2 | Text | VAQTA | Presence-Content Indifferent |
| RXA-5.3 | Name of Coding System | NDC | Value-Test Case Fixed |
| RXA-5.5 | Alternate Text | Indifferent | |
| RXA-5.6 | Name of Alternate Coding System | Indifferent | |
| RXA-6 | Administered Amount | 0.5 | Value-Test Case Fixed |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | mL | Value-Test Case Fixed |
| RXA-7.2 | Text | mL | Presence-Content Indifferent |
| RXA-7.3 | Name of Coding System | UCUM | Value-Test Case Fixed |
| RXA-7.5 | Alternate Text | Indifferent | |
| RXA-7.6 | Name of Alternate Coding System | Indifferent | |
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 00 | Value-Test Case Fixed |
| RXA-9.2 | Text | New Record | Presence-Content Indifferent |
| RXA-9.3 | Name of Coding System | NIP001 | Value-Profile Fixed |
| RXA-9.5 | Alternate Text | Indifferent | |
| RXA-9.6 | Name of Alternate Coding System | Indifferent | |
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Lily | Presence-Content Indifferent |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | L | Presence-Content Indifferent |
| RXA-10.12 | Check Digit Scheme | Indifferent | |
| RXA-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-11.4.2 | Universal ID | Indifferent | |
| RXA-11.4.3 | Universal ID Type | Indifferent | |
| RXA-15 | Substance Lot Number | 208490 | Presence-Content Indifferent |
| RXA-16 | Substance Expiration Date | ||
| RXA-16.1 | Time | 20160120 | Presence-Content Indifferent |
| RXA-17 | Substance Manufacturer Name | ||
| RXA-17.1 | Identifier | MSD | Presence-Content Indifferent |
| RXA-17.2 | Text | Merck and Co., Inc. | Presence-Content Indifferent |
| RXA-17.3 | Name of Coding System | MVX | Value-Test Case Fixed |
| RXA-17.5 | Alternate Text | Indifferent | |
| RXA-17.6 | Name of Alternate Coding System | Indifferent | |
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | Indifferent | |
| RXA-18.2 | Text | Indifferent | |
| RXA-18.3 | Name of Coding System | Indifferent | |
| RXA-18.5 | Alternate Text | Indifferent | |
| RXA-18.6 | Name of Alternate Coding System | Indifferent | |
| RXA-20 | Completion Status | CP | Value-Test Case Fixed |
| RXA-21 | Action Code - RXA | U | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR-1 | Route | ||
| RXR-1.1 | Identifier | C28161 | Presence-Content Indifferent |
| RXR-1.2 | Text | Intramuscular | Presence-Content Indifferent |
| RXR-1.3 | Name of Coding System | NCIT | Value-Profile Fixed |
| RXR-1.5 | Alternate Text | Indifferent | |
| RXR-1.6 | Name of Alternate Coding System | Indifferent | |
| RXR-2 | Administration Site | ||
| RXR-2.1 | Identifier | RT | Presence-Content Indifferent |
| RXR-2.2 | Text | Right Thigh | Presence-Content Indifferent |
| RXR-2.3 | Name of Coding System | HL70163 | Value-Profile Fixed |
| RXR-2.5 | Alternate Text | Indifferent | |
| RXR-2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 1 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30963-3 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Source | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 1 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 2 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 64994-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Program Eligibility | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 2 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | VXC40 | Value-Test Case Fixed |
| OBX-17.2 | Text | per immunization | Presence-Content Indifferent |
| OBX-17.3 | Name of Coding System | CDCPHINVS | Value-Profile Fixed |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 3 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 69764-9 | Value-Test Case Fixed |
| OBX-3.2 | Text | Document Type | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 4 | Value-Profile Fixed |
| OBX-2 | Value Type | DT | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 29769-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Date Vis Presented | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | 20150624 | Presence-Content Indifferent |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | wcApp | Presence-Content Indifferent |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | iisApp | Presence-Content Indifferent |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | IIS | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150624093847.808-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | VXU | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | VXU_V04 | Value-Profile Fixed |
| MSH-10 | Message Control ID | 18019 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | ER | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | AL | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z22 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | wcEHR | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | Indifferent | |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | Indifferent | |
| MSH-22.10 | Organization Identifier | Indifferent | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | IIS | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | Indifferent | |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | Indifferent | |
| MSH-23.10 | Organization Identifier | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID-1 | Set ID - PID | 1 | Value-Profile Fixed |
| PID-3 | Patient Identifier List | ||
| PID-3.1 | ID Number | 8891 | Presence-Content Indifferent |
| PID-3.3 | Check Digit Scheme | Indifferent | |
| PID-3.4 | Assigning Authority | ||
| PID-3.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| PID-3.4.2 | Universal ID | Indifferent | |
| PID-3.4.3 | Universal ID Type | Indifferent | |
| PID-3.5 | Identifier Type Code | MR | Presence-Content Indifferent |
| PID-5 | Patient Name | ||
| PID-5.1 | Family Name | ||
| PID-5.1.1 | Surname | Banks | Presence-Content Indifferent |
| PID-5.1.2 | Own Surname Prefix | ||
| PID-5.1.3 | Own Surname | ||
| PID-5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-5.1.5 | Surname From Partner/Spouse | ||
| PID-5.2 | Given Name | Tyler | Presence-Content Indifferent |
| PID-5.3 | Second and Further Given Names or Initials Thereof | Owen | Presence-Content Indifferent |
| PID-5.7 | Name Type Code | L | Presence-Content Indifferent |
| PID-6 | Mother's Maiden Name | ||
| PID-6.1 | Family Name | ||
| PID-6.1.1 | Surname | Indifferent | |
| PID-6.1.2 | Own Surname Prefix | ||
| PID-6.1.3 | Own Surname | ||
| PID-6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-6.1.5 | Surname From Partner/Spouse | ||
| PID-6.7 | Name Type Code | Indifferent | |
| PID-7 | Date/Time of Birth | ||
| PID-7.1 | Time | 20140602 | Presence-Content Indifferent |
| PID-8 | Administrative Sex | M | Presence-Content Indifferent |
| PID-10 | Race | ||
| PID-10.1 | Identifier | 2106-3 | Presence-Content Indifferent |
| PID-10.2 | Text | White | Presence-Content Indifferent |
| PID-10.3 | Name of Coding System | CDCREC | Value-Profile Fixed |
| PID-10.5 | Alternate Text | Indifferent | |
| PID-10.6 | Name of Alternate Coding System | Indifferent | |
| PID-11 | Patient Address | ||
| PID-11.1 | Street Address | ||
| PID-11.1.1 | Street or Mailing Address | 924 Sycamore Lane | Presence-Content Indifferent |
| PID-11.1.2 | Street Name | ||
| PID-11.1.3 | Dwelling Number | ||
| PID-11.2 | Other Designation | Indifferent | |
| PID-11.3 | City | Bozeman | Presence-Content Indifferent |
| PID-11.4 | State or Province | MT | Presence-Content Indifferent |
| PID-11.5 | Zip or Postal Code | 59715 | Presence-Content Indifferent |
| PID-11.6 | Country | USA | Presence-Content Indifferent |
| PID-11.7 | Address Type | P | Presence-Content Indifferent |
| PID-13 | Phone Number - Home | ||
| PID-13.2 | Telecommunication Use Code | PRN | Presence-Content Indifferent |
| PID-13.3 | Telecommunication Equipment Type | PH | Value-Test Case Fixed |
| PID-13.4 | Email Address | NonPresence | |
| PID-13.6 | Area/City Code | 406 | Presence-Content Indifferent |
| PID-13.7 | Local Number | 5555835 | Presence-Content Indifferent |
| PID-22 | Ethnic Group | ||
| PID-22.1 | Identifier | 2186-5 | Presence-Content Indifferent |
| PID-22.2 | Text | Not Hispanic or Latino | Presence-Content Indifferent |
| PID-22.3 | Name of Coding System | CDCREC | Value-Profile Fixed |
| PID-22.5 | Alternate Text | Indifferent | |
| PID-22.6 | Name of Alternate Coding System | Indifferent | |
| PID-24 | Multiple Birth Indicator | Y | Value-Test Case Fixed |
| PID-25 | Birth Order | 2 | Value-Test Case Fixed |
| PID-29 | Patient Death Date and Time | ||
| PID-29.1 | Time | Indifferent | |
| PID-30 | Patient Death Indicator | N | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1-11 | Publicity Code | ||
| PD1-11.1 | Identifier | 02 | Presence-Content Indifferent |
| PD1-11.2 | Text | Reminder/recall - any method | Presence-Content Indifferent |
| PD1-11.3 | Name of Coding System | HL70215 | Value-Profile Fixed |
| PD1-11.5 | Alternate Text | Indifferent | |
| PD1-11.6 | Name of Alternate Coding System | Indifferent | |
| PD1-12 | Protection Indicator | Y | Value-Test Case Fixed |
| PD1-13 | Protection Indicator Effective Date | 20150624 | Presence-Content Indifferent |
| PD1-16 | Immunization Registry Status | A | Presence-Content Indifferent |
| PD1-17 | Immunization Registry Status Effective Date | 20040602 | Presence-Content Indifferent |
| PD1-18 | Publicity Code Effective Date | 20150624 | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| NK1-1 | Set ID - NK1 | 1 | Value-Profile Fixed |
| NK1-2 | Name | ||
| NK1-2.1 | Family Name | ||
| NK1-2.1.1 | Surname | Banks | Presence-Content Indifferent |
| NK1-2.1.2 | Own Surname Prefix | ||
| NK1-2.1.3 | Own Surname | ||
| NK1-2.1.4 | Surname Prefix From Partner/Spouse | ||
| NK1-2.1.5 | Surname From Partner/Spouse | ||
| NK1-2.2 | Given Name | Karl | Presence-Content Indifferent |
| NK1-2.3 | Second and Further Given Names or Initials Thereof | Leonard | Presence-Content Indifferent |
| NK1-2.7 | Name Type Code | L | Presence-Content Indifferent |
| NK1-3 | Relationship | ||
| NK1-3.1 | Identifier | FTH | Presence-Content Indifferent |
| NK1-3.2 | Text | Father | Presence-Content Indifferent |
| NK1-3.3 | Name of Coding System | HL70063 | Value-Profile Fixed |
| NK1-3.5 | Alternate Text | Indifferent | |
| NK1-3.6 | Name of Alternate Coding System | Indifferent | |
| NK1-4 | Address | ||
| NK1-4.1 | Street Address | ||
| NK1-4.1.1 | Street or Mailing Address | 924 Sycamore Lane | Presence-Content Indifferent |
| NK1-4.1.2 | Street Name | ||
| NK1-4.1.3 | Dwelling Number | ||
| NK1-4.2 | Other Designation | Indifferent | |
| NK1-4.3 | City | Bozeman | Presence-Content Indifferent |
| NK1-4.4 | State or Province | MT | Presence-Content Indifferent |
| NK1-4.5 | Zip or Postal Code | 59715 | Presence-Content Indifferent |
| NK1-4.6 | Country | USA | Presence-Content Indifferent |
| NK1-4.7 | Address Type | P | Presence-Content Indifferent |
| NK1-5 | Phone Number | ||
| NK1-5.2 | Telecommunication Use Code | PRN | Presence-Content Indifferent |
| NK1-5.3 | Telecommunication Equipment Type | PH | Value-Test Case Fixed |
| NK1-5.4 | Email Address | NonPresence | |
| NK1-5.6 | Area/City Code | 406 | Presence-Content Indifferent |
| NK1-5.7 | Local Number | 5555835 | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | Value-Profile Fixed |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | 5027 | Presence-Content Indifferent |
| ORC-2.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-2.3 | Universal ID | Indifferent | |
| ORC-2.4 | Universal ID Type | Indifferent | |
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 12128 | Presence-Content Indifferent |
| ORC-3.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-3.3 | Universal ID | Indifferent | |
| ORC-3.4 | Universal ID Type | Indifferent | |
| ORC-10 | Entered By | ||
| ORC-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| ORC-10.2 | Family Name | ||
| ORC-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| ORC-10.2.2 | Own Surname Prefix | ||
| ORC-10.2.3 | Own Surname | ||
| ORC-10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-10.2.5 | Surname From Partner/Spouse | ||
| ORC-10.3 | Given Name | Lily | Presence-Content Indifferent |
| ORC-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| ORC-10.9 | Assigning Authority | ||
| ORC-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-10.9.2 | Universal ID | ||
| ORC-10.9.3 | Universal ID Type | ||
| ORC-10.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-10.12 | Check Digit Scheme | Indifferent | |
| ORC-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| ORC-12 | Ordering Provider | ||
| ORC-12.1 | ID Number | 654 | Presence-Content Indifferent |
| ORC-12.2 | Family Name | ||
| ORC-12.2.1 | Surname | Thomas | Presence-Content Indifferent |
| ORC-12.2.2 | Own Surname Prefix | ||
| ORC-12.2.3 | Own Surname | ||
| ORC-12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-12.2.5 | Surname From Partner/Spouse | ||
| ORC-12.3 | Given Name | Wilma | Presence-Content Indifferent |
| ORC-12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | Presence-Content Indifferent |
| ORC-12.9 | Assigning Authority | ||
| ORC-12.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-12.9.2 | Universal ID | ||
| ORC-12.9.3 | Universal ID Type | ||
| ORC-12.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-12.12 | Check Digit Scheme | Indifferent | |
| ORC-12.13 | Identifier Type Code | MD | Presence-Content Indifferent |
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | wcEHR | Presence-Content Indifferent |
| ORC-17.2 | Text | West Clinic | Presence-Content Indifferent |
| ORC-17.3 | Name of Coding System | HL70362 | Value-Profile Fixed |
| ORC-17.5 | Alternate Text | Indifferent | |
| ORC-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | Value-Profile Fixed |
| RXA-2 | Administration Sub-ID Counter | 1 | Value-Profile Fixed |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20150624 | Presence-Content Indifferent |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 00006-4095-01 | Value-Test Case Fixed |
| RXA-5.2 | Text | VAQTA | Presence-Content Indifferent |
| RXA-5.3 | Name of Coding System | NDC | Value-Test Case Fixed |
| RXA-5.5 | Alternate Text | Indifferent | |
| RXA-5.6 | Name of Alternate Coding System | Indifferent | |
| RXA-6 | Administered Amount | 0.5 | Value-Test Case Fixed |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | mL | Value-Test Case Fixed |
| RXA-7.2 | Text | mL | Presence-Content Indifferent |
| RXA-7.3 | Name of Coding System | UCUM | Value-Test Case Fixed |
| RXA-7.5 | Alternate Text | Indifferent | |
| RXA-7.6 | Name of Alternate Coding System | Indifferent | |
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 00 | Value-Test Case Fixed |
| RXA-9.2 | Text | New Record | Presence-Content Indifferent |
| RXA-9.3 | Name of Coding System | NIP001 | Value-Profile Fixed |
| RXA-9.5 | Alternate Text | Indifferent | |
| RXA-9.6 | Name of Alternate Coding System | Indifferent | |
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Lily | Presence-Content Indifferent |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | L | Presence-Content Indifferent |
| RXA-10.12 | Check Digit Scheme | Indifferent | |
| RXA-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-11.4.2 | Universal ID | Indifferent | |
| RXA-11.4.3 | Universal ID Type | Indifferent | |
| RXA-15 | Substance Lot Number | 208490 | Presence-Content Indifferent |
| RXA-16 | Substance Expiration Date | ||
| RXA-16.1 | Time | 20160120 | Presence-Content Indifferent |
| RXA-17 | Substance Manufacturer Name | ||
| RXA-17.1 | Identifier | MSD | Presence-Content Indifferent |
| RXA-17.2 | Text | Merck and Co., Inc. | Presence-Content Indifferent |
| RXA-17.3 | Name of Coding System | MVX | Value-Test Case Fixed |
| RXA-17.5 | Alternate Text | Indifferent | |
| RXA-17.6 | Name of Alternate Coding System | Indifferent | |
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | Indifferent | |
| RXA-18.2 | Text | Indifferent | |
| RXA-18.3 | Name of Coding System | Indifferent | |
| RXA-18.5 | Alternate Text | Indifferent | |
| RXA-18.6 | Name of Alternate Coding System | Indifferent | |
| RXA-20 | Completion Status | CP | Value-Test Case Fixed |
| RXA-21 | Action Code - RXA | U | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR-1 | Route | ||
| RXR-1.1 | Identifier | C28161 | Presence-Content Indifferent |
| RXR-1.2 | Text | Intramuscular | Presence-Content Indifferent |
| RXR-1.3 | Name of Coding System | NCIT | Value-Profile Fixed |
| RXR-1.5 | Alternate Text | Indifferent | |
| RXR-1.6 | Name of Alternate Coding System | Indifferent | |
| RXR-2 | Administration Site | ||
| RXR-2.1 | Identifier | RT | Presence-Content Indifferent |
| RXR-2.2 | Text | Right Thigh | Presence-Content Indifferent |
| RXR-2.3 | Name of Coding System | HL70163 | Value-Profile Fixed |
| RXR-2.5 | Alternate Text | Indifferent | |
| RXR-2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 1 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30963-3 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Source | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 1 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 2 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 64994-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Program Eligibility | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 2 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | VXC40 | Value-Test Case Fixed |
| OBX-17.2 | Text | per immunization | Presence-Content Indifferent |
| OBX-17.3 | Name of Coding System | CDCPHINVS | Value-Profile Fixed |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 3 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 69764-9 | Value-Test Case Fixed |
| OBX-3.2 | Text | Document Type | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 4 | Value-Profile Fixed |
| OBX-2 | Value Type | DT | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 29769-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Date Vis Presented | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | 20150624 | Presence-Content Indifferent |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150624 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Element | Data |
|---|---|
| Patient Name | Tyler Owen Banks |
| Mother's Maiden Name | |
| ID Number | 8891 |
| Date/Time of Birth | 06/02/2014 |
| Administrative Sex | Male |
| Patient Address | 924 Sycamore Lane Bozeman MT 59715 USA |
| Local Number | (406)555-5835 |
| Race | White |
| Ethnic Group | Not Hispanic or Latino |
| Multiple Birth Indicator | Y |
| Birth Order | 2 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 06/02/2004 |
| Publicity Code | Reminder/recall - any method |
| Publicity Code Effective Date | 06/24/2015 |
| Protection Indicator | Yes |
| Protection Indicator Effective Date | 06/24/2015 |
| Element | Data |
|---|---|
| Name | Karl Leonard Banks |
| Relationship | Father |
| Address | 924 Sycamore Lane Bozeman MT 59715 USA |
| Phone Number | (406)555-5835 |
| Element | Data |
|---|---|
| Administered Code | VAQTA |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 208490 |
| Substance Expiration Date | 01/20/2016 |
| Substance Manufacturer Name | Merck and Co., Inc. |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Update |
| Route | Intramuscular |
| Administration Site | Right Thigh |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Private |
| Vaccine Funding Program Eligibility | Not VFC Eligible |
| Document Type | Hepatitis A VIS |
| Date Vis Presented | 06/24/2015 |
| Element | Data |
|---|---|
| Patient Name | Tyler Owen Banks |
| Mother's Maiden Name | |
| ID Number | 8891 |
| Date/Time of Birth | 06/02/2014 |
| Administrative Sex | Male |
| Patient Address | 924 Sycamore Lane Bozeman MT 59715 USA |
| Local Number | (406)555-5835 |
| Race | White |
| Ethnic Group | Not Hispanic or Latino |
| Multiple Birth Indicator | Y |
| Birth Order | 2 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 06/02/2004 |
| Publicity Code | Reminder/recall - any method |
| Publicity Code Effective Date | 06/24/2015 |
| Protection Indicator | Yes |
| Protection Indicator Effective Date | 06/24/2015 |
| Element | Data |
|---|---|
| Name | Karl Leonard Banks |
| Relationship | Father |
| Address | 924 Sycamore Lane Bozeman MT 59715 USA |
| Phone Number | (406)555-5835 |
| Element | Data |
|---|---|
| Administered Code | VAQTA |
| Date/Time Start of Administration | 06/24/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 208490 |
| Substance Expiration Date | 01/20/2016 |
| Substance Manufacturer Name | Merck and Co., Inc. |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Update |
| Route | Intramuscular |
| Administration Site | Right Thigh |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Private |
| Vaccine Funding Program Eligibility | Not VFC Eligible |
| Document Type | Hepatitis A VIS |
| Date Vis Presented | 06/24/2015 |
| Description |
|---|
| The IIS returns a positive acknowledgement message indicating that no errors were found during the course of filing the message. |
| Comments |
|---|
| No Comments |
| Pre Condition |
|---|
| A VXU message is generated by the EHR. |
| Post Condition |
|---|
| No PostCondition |
| Test Objectives |
|---|
| Evaluation Criteria |
|---|
| The acknowledgement message is consumed by the system responsible for the content of the administration message without error. |
| Notes for Testers |
|---|
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | iisApp | Presence-Content Indifferent |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | IIS | Presence-Content Indifferent |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | wcApp | Presence-Content Indifferent |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150624093847.822-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | ACK | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | ACK | Value-Profile Fixed |
| MSH-10 | Message Control ID | 79946 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z23 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | IIS | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | Indifferent | |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | Indifferent | |
| MSH-22.10 | Organization Identifier | Indifferent | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | wcEHR | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | Indifferent | |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | Indifferent | |
| MSH-23.10 | Organization Identifier | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA-1 | Acknowledgment Code | AA | Value-Test Case Fixed |
| MSA-2 | Message Control ID | 18019 | Presence-System Generated |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | iisApp | Presence-Content Indifferent |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | IIS | Presence-Content Indifferent |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | wcApp | Presence-Content Indifferent |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150624093847.822-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | ACK | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | ACK | Value-Profile Fixed |
| MSH-10 | Message Control ID | 79946 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z23 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | IIS | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | Indifferent | |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | Indifferent | |
| MSH-22.10 | Organization Identifier | Indifferent | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | wcEHR | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | Indifferent | |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | Indifferent | |
| MSH-23.10 | Organization Identifier | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA-1 | Acknowledgment Code | AA | Value-Test Case Fixed |
| MSA-2 | Message Control ID | 18019 | Presence-System Generated |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Return an Acknowledgement | |||||
|---|---|---|---|---|---|
| Test Case ID | IZ-AD-6_Update_Record | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement (Pass/Fail) |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which NO Error is returned in the message.
The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.
| Return an Acknowledgement |
|---|
|
The receiving HIT system being tested shall process the Z23 ACK message correctly; a positive notification indicating that the ACK message was processed correctly need not be made visible in the system. |
| Description |
|---|
| A patient is seen at a clinic. A historical vaccination is recorded but the IIS is unable to process the administration message, rejects it and returns a fatal error in the acknowledgement message. |
| Comments |
|---|
| No Comments |
| Pre Condition |
|---|
| No PreCondition |
| Post Condition |
|---|
| The returned error must be visible in the EHR. |
| Test Objectives |
|---|
| This test case assesses the ability of the EHR to accept an acknowledgement message with a fatal error being returned by the IIS. |
| Evaluation Criteria |
|---|
| Notes for Testers |
|---|
| No Note |
| Description |
|---|
| A 66 year old female, Helen Barrett, comes to a clinic for a physical. A clinic staff member collects basic patient demographic information including name, date of birth and sex. The patient reports that she received a Zoster vaccination at a local pharmacy on her 65th birthday. The clinic staff determine that no further vaccinations are required. A clinician, Lily Jackson (ID 7824) enters the historical data into the EHR and transmits it to the IIS. |
| Comments |
|---|
| No Comments |
| Pre Condition |
|---|
| No PreCondition |
| Post Condition |
|---|
| No PostCondition |
| Test Objectives |
|---|
| Support for Sending Responsible Organization (MSH-22) and Receiving Responsible Organization (MSH-23). |
| Evaluation Criteria |
|---|
| Message Validation Report. |
| Notes for Testers |
|---|
| Tester should refer to the Message Content tab for expected elements needed to be valued in MSH-22 and MSH-23. Examples values are provided. |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | wcApp | Presence-Content Indifferent |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | iisApp | Presence-Content Indifferent |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | IIS | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150625121047.839-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | VXU | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | VXU_V04 | Value-Profile Fixed |
| MSH-10 | Message Control ID | 35560 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | ER | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | AL | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z22 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | wcEHR | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | Indifferent | |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | Indifferent | |
| MSH-22.10 | Organization Identifier | Indifferent | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | IIS | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | Indifferent | |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | Indifferent | |
| MSH-23.10 | Organization Identifier | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID-1 | Set ID - PID | 1 | Value-Profile Fixed |
| PID-3 | Patient Identifier List | ||
| PID-3.1 | ID Number | 7120 | Presence-Content Indifferent |
| PID-3.3 | Check Digit Scheme | Indifferent | |
| PID-3.4 | Assigning Authority | ||
| PID-3.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| PID-3.4.2 | Universal ID | Indifferent | |
| PID-3.4.3 | Universal ID Type | Indifferent | |
| PID-3.5 | Identifier Type Code | MR | Presence-Content Indifferent |
| PID-5 | Patient Name | ||
| PID-5.1 | Family Name | ||
| PID-5.1.1 | Surname | Barrett | Presence-Content Indifferent |
| PID-5.1.2 | Own Surname Prefix | ||
| PID-5.1.3 | Own Surname | ||
| PID-5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-5.1.5 | Surname From Partner/Spouse | ||
| PID-5.2 | Given Name | Helen | Presence-Content Indifferent |
| PID-5.3 | Second and Further Given Names or Initials Thereof | Indifferent | |
| PID-5.7 | Name Type Code | L | Presence-Content Indifferent |
| PID-6 | Mother's Maiden Name | ||
| PID-6.1 | Family Name | ||
| PID-6.1.1 | Surname | Indifferent | |
| PID-6.1.2 | Own Surname Prefix | ||
| PID-6.1.3 | Own Surname | ||
| PID-6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-6.1.5 | Surname From Partner/Spouse | ||
| PID-6.7 | Name Type Code | Indifferent | |
| PID-7 | Date/Time of Birth | ||
| PID-7.1 | Time | 19500317 | Presence-Content Indifferent |
| PID-8 | Administrative Sex | F | Presence-Content Indifferent |
| PID-10 | Race | ||
| PID-10.1 | Identifier | 2106-3 | Presence-Content Indifferent |
| PID-10.2 | Text | White | Presence-Content Indifferent |
| PID-10.3 | Name of Coding System | CDCREC | Value-Profile Fixed |
| PID-10.5 | Alternate Text | Indifferent | |
| PID-10.6 | Name of Alternate Coding System | Indifferent | |
| PID-11 | Patient Address | ||
| PID-11.1 | Street Address | ||
| PID-11.1.1 | Street or Mailing Address | 763 Main St | Presence-Content Indifferent |
| PID-11.1.2 | Street Name | ||
| PID-11.1.3 | Dwelling Number | ||
| PID-11.2 | Other Designation | Indifferent | |
| PID-11.3 | City | Bozeman | Presence-Content Indifferent |
| PID-11.4 | State or Province | MT | Presence-Content Indifferent |
| PID-11.5 | Zip or Postal Code | 59715 | Presence-Content Indifferent |
| PID-11.6 | Country | USA | Presence-Content Indifferent |
| PID-11.7 | Address Type | P | Presence-Content Indifferent |
| PID-13[1] | Phone Number - Home | ||
| PID-13[1].2 | Telecommunication Use Code | PRN | Presence-Content Indifferent |
| PID-13[1].3 | Telecommunication Equipment Type | PH | Value-Test Case Fixed |
| PID-13[1].4 | Email Address | NonPresence | |
| PID-13[1].6 | Area/City Code | 406 | Presence-Content Indifferent |
| PID-13[1].7 | Local Number | 5554064 | Presence-Content Indifferent |
| PID-13[2] | Phone Number - Home | ||
| PID-13[2].2 | Telecommunication Use Code | NET | Presence-Content Indifferent |
| PID-13[2].3 | Telecommunication Equipment Type | NonPresence | |
| PID-13[2].4 | Email Address | Helen.Barrett@isp.com | Presence-Content Indifferent |
| PID-13[2].6 | Area/City Code | NonPresence | |
| PID-13[2].7 | Local Number | NonPresence | |
| PID-22 | Ethnic Group | ||
| PID-22.1 | Identifier | 2186-5 | Presence-Content Indifferent |
| PID-22.2 | Text | Not Hispanic or Latino | Presence-Content Indifferent |
| PID-22.3 | Name of Coding System | CDCREC | Value-Profile Fixed |
| PID-22.5 | Alternate Text | Indifferent | |
| PID-22.6 | Name of Alternate Coding System | Indifferent | |
| PID-24 | Multiple Birth Indicator | N | Presence-Content Indifferent |
| PID-25 | Birth Order | 1 | Indifferent |
| PID-29 | Patient Death Date and Time | ||
| PID-29.1 | Time | Indifferent | |
| PID-30 | Patient Death Indicator | N | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1-11 | Publicity Code | ||
| PD1-11.1 | Identifier | 06 | Presence-Content Indifferent |
| PD1-11.2 | Text | Recall only - any method | Presence-Content Indifferent |
| PD1-11.3 | Name of Coding System | HL70215 | Value-Profile Fixed |
| PD1-11.5 | Alternate Text | Indifferent | |
| PD1-11.6 | Name of Alternate Coding System | Indifferent | |
| PD1-12 | Protection Indicator | Y | Value-Test Case Fixed |
| PD1-13 | Protection Indicator Effective Date | 20150625 | Presence-Content Indifferent |
| PD1-16 | Immunization Registry Status | A | Presence-Content Indifferent |
| PD1-17 | Immunization Registry Status Effective Date | 19500317 | Presence-Content Indifferent |
| PD1-18 | Publicity Code Effective Date | 20150625 | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | Value-Profile Fixed |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | 7646 | Presence-Content Indifferent |
| ORC-2.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-2.3 | Universal ID | Indifferent | |
| ORC-2.4 | Universal ID Type | Indifferent | |
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 53100 | Presence-Content Indifferent |
| ORC-3.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-3.3 | Universal ID | Indifferent | |
| ORC-3.4 | Universal ID Type | Indifferent | |
| ORC-10 | Entered By | ||
| ORC-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| ORC-10.2 | Family Name | ||
| ORC-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| ORC-10.2.2 | Own Surname Prefix | ||
| ORC-10.2.3 | Own Surname | ||
| ORC-10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-10.2.5 | Surname From Partner/Spouse | ||
| ORC-10.3 | Given Name | Lily | Presence-Content Indifferent |
| ORC-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| ORC-10.9 | Assigning Authority | ||
| ORC-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-10.9.2 | Universal ID | ||
| ORC-10.9.3 | Universal ID Type | ||
| ORC-10.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-10.12 | Check Digit Scheme | Indifferent | |
| ORC-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| ORC-12 | Ordering Provider | ||
| ORC-12.1 | ID Number | Indifferent | |
| ORC-12.2 | Family Name | ||
| ORC-12.2.1 | Surname | Indifferent | |
| ORC-12.2.2 | Own Surname Prefix | ||
| ORC-12.2.3 | Own Surname | ||
| ORC-12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-12.2.5 | Surname From Partner/Spouse | ||
| ORC-12.3 | Given Name | Indifferent | |
| ORC-12.4 | Second and Further Given Names or Initials Thereof | Indifferent | |
| ORC-12.9 | Assigning Authority | ||
| ORC-12.9.1 | Namespace ID | Indifferent | |
| ORC-12.9.2 | Universal ID | Indifferent | |
| ORC-12.9.3 | Universal ID Type | Indifferent | |
| ORC-12.10 | Name Type Code | Indifferent | |
| ORC-12.12 | Check Digit Scheme | Indifferent | |
| ORC-12.13 | Identifier Type Code | Indifferent | |
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | wcEHR | Presence-Content Indifferent |
| ORC-17.2 | Text | West Clinic | Presence-Content Indifferent |
| ORC-17.3 | Name of Coding System | HL70362 | Value-Profile Fixed |
| ORC-17.5 | Alternate Text | Indifferent | |
| ORC-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | Value-Profile Fixed |
| RXA-2 | Administration Sub-ID Counter | 1 | Value-Profile Fixed |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20150317 | Presence-Content Indifferent |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 121 | Value-Test Case Fixed |
| RXA-5.2 | Text | zoster | Presence-Content Indifferent |
| RXA-5.3 | Name of Coding System | CVX | Value-Test Case Fixed |
| RXA-5.5 | Alternate Text | Indifferent | |
| RXA-5.6 | Name of Alternate Coding System | Indifferent | |
| RXA-6 | Administered Amount | 999 | Value-Test Case Fixed |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | NonPresence | |
| RXA-7.2 | Text | NonPresence | |
| RXA-7.3 | Name of Coding System | NonPresence | |
| RXA-7.5 | Alternate Text | NonPresence | |
| RXA-7.6 | Name of Alternate Coding System | NonPresence | |
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 01 | Value-Test Case Fixed |
| RXA-9.2 | Text | Historical Administration | Presence-Content Indifferent |
| RXA-9.3 | Name of Coding System | NIP001 | Value-Profile Fixed |
| RXA-9.5 | Alternate Text | Indifferent | |
| RXA-9.6 | Name of Alternate Coding System | Indifferent | |
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | Indifferent | |
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Indifferent | |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Indifferent | |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | Indifferent | |
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | Indifferent | |
| RXA-10.9.2 | Universal ID | Indifferent | |
| RXA-10.9.3 | Universal ID Type | Indifferent | |
| RXA-10.10 | Name Type Code | Indifferent | |
| RXA-10.12 | Check Digit Scheme | Indifferent | |
| RXA-10.13 | Identifier Type Code | Indifferent | |
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | Indifferent | |
| RXA-11.4.2 | Universal ID | Indifferent | |
| RXA-11.4.3 | Universal ID Type | Indifferent | |
| RXA-15 | Substance Lot Number | Indifferent | |
| RXA-16 | Substance Expiration Date | ||
| RXA-16.1 | Time | Indifferent | |
| RXA-17 | Substance Manufacturer Name | ||
| RXA-17.1 | Identifier | Indifferent | |
| RXA-17.2 | Text | Indifferent | |
| RXA-17.3 | Name of Coding System | Indifferent | |
| RXA-17.5 | Alternate Text | Indifferent | |
| RXA-17.6 | Name of Alternate Coding System | Indifferent | |
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | Indifferent | |
| RXA-18.2 | Text | Indifferent | |
| RXA-18.3 | Name of Coding System | Indifferent | |
| RXA-18.5 | Alternate Text | Indifferent | |
| RXA-18.6 | Name of Alternate Coding System | Indifferent | |
| RXA-20 | Completion Status | CP | Value-Test Case Fixed |
| RXA-21 | Action Code - RXA | A | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | wcApp | Presence-Content Indifferent |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | iisApp | Presence-Content Indifferent |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | IIS | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150625121047.839-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | VXU | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | VXU_V04 | Value-Profile Fixed |
| MSH-10 | Message Control ID | 35560 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | ER | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | AL | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z22 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | wcEHR | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | Indifferent | |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | Indifferent | |
| MSH-22.10 | Organization Identifier | Indifferent | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | IIS | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | Indifferent | |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | Indifferent | |
| MSH-23.10 | Organization Identifier | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID-1 | Set ID - PID | 1 | Value-Profile Fixed |
| PID-3 | Patient Identifier List | ||
| PID-3.1 | ID Number | 7120 | Presence-Content Indifferent |
| PID-3.3 | Check Digit Scheme | Indifferent | |
| PID-3.4 | Assigning Authority | ||
| PID-3.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| PID-3.4.2 | Universal ID | Indifferent | |
| PID-3.4.3 | Universal ID Type | Indifferent | |
| PID-3.5 | Identifier Type Code | MR | Presence-Content Indifferent |
| PID-5 | Patient Name | ||
| PID-5.1 | Family Name | ||
| PID-5.1.1 | Surname | Barrett | Presence-Content Indifferent |
| PID-5.1.2 | Own Surname Prefix | ||
| PID-5.1.3 | Own Surname | ||
| PID-5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-5.1.5 | Surname From Partner/Spouse | ||
| PID-5.2 | Given Name | Helen | Presence-Content Indifferent |
| PID-5.3 | Second and Further Given Names or Initials Thereof | Indifferent | |
| PID-5.7 | Name Type Code | L | Presence-Content Indifferent |
| PID-6 | Mother's Maiden Name | ||
| PID-6.1 | Family Name | ||
| PID-6.1.1 | Surname | Indifferent | |
| PID-6.1.2 | Own Surname Prefix | ||
| PID-6.1.3 | Own Surname | ||
| PID-6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-6.1.5 | Surname From Partner/Spouse | ||
| PID-6.7 | Name Type Code | Indifferent | |
| PID-7 | Date/Time of Birth | ||
| PID-7.1 | Time | 19500317 | Presence-Content Indifferent |
| PID-8 | Administrative Sex | F | Presence-Content Indifferent |
| PID-10 | Race | ||
| PID-10.1 | Identifier | 2106-3 | Presence-Content Indifferent |
| PID-10.2 | Text | White | Presence-Content Indifferent |
| PID-10.3 | Name of Coding System | CDCREC | Value-Profile Fixed |
| PID-10.5 | Alternate Text | Indifferent | |
| PID-10.6 | Name of Alternate Coding System | Indifferent | |
| PID-11 | Patient Address | ||
| PID-11.1 | Street Address | ||
| PID-11.1.1 | Street or Mailing Address | 763 Main St | Presence-Content Indifferent |
| PID-11.1.2 | Street Name | ||
| PID-11.1.3 | Dwelling Number | ||
| PID-11.2 | Other Designation | Indifferent | |
| PID-11.3 | City | Bozeman | Presence-Content Indifferent |
| PID-11.4 | State or Province | MT | Presence-Content Indifferent |
| PID-11.5 | Zip or Postal Code | 59715 | Presence-Content Indifferent |
| PID-11.6 | Country | USA | Presence-Content Indifferent |
| PID-11.7 | Address Type | P | Presence-Content Indifferent |
| PID-13[1] | Phone Number - Home | ||
| PID-13[1].2 | Telecommunication Use Code | PRN | Presence-Content Indifferent |
| PID-13[1].3 | Telecommunication Equipment Type | PH | Value-Test Case Fixed |
| PID-13[1].4 | Email Address | NonPresence | |
| PID-13[1].6 | Area/City Code | 406 | Presence-Content Indifferent |
| PID-13[1].7 | Local Number | 5554064 | Presence-Content Indifferent |
| PID-13[2] | Phone Number - Home | ||
| PID-13[2].2 | Telecommunication Use Code | NET | Presence-Content Indifferent |
| PID-13[2].3 | Telecommunication Equipment Type | NonPresence | |
| PID-13[2].4 | Email Address | Helen.Barrett@isp.com | Presence-Content Indifferent |
| PID-13[2].6 | Area/City Code | NonPresence | |
| PID-13[2].7 | Local Number | NonPresence | |
| PID-22 | Ethnic Group | ||
| PID-22.1 | Identifier | 2186-5 | Presence-Content Indifferent |
| PID-22.2 | Text | Not Hispanic or Latino | Presence-Content Indifferent |
| PID-22.3 | Name of Coding System | CDCREC | Value-Profile Fixed |
| PID-22.5 | Alternate Text | Indifferent | |
| PID-22.6 | Name of Alternate Coding System | Indifferent | |
| PID-24 | Multiple Birth Indicator | N | Presence-Content Indifferent |
| PID-25 | Birth Order | 1 | Indifferent |
| PID-29 | Patient Death Date and Time | ||
| PID-29.1 | Time | Indifferent | |
| PID-30 | Patient Death Indicator | N | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1-11 | Publicity Code | ||
| PD1-11.1 | Identifier | 06 | Presence-Content Indifferent |
| PD1-11.2 | Text | Recall only - any method | Presence-Content Indifferent |
| PD1-11.3 | Name of Coding System | HL70215 | Value-Profile Fixed |
| PD1-11.5 | Alternate Text | Indifferent | |
| PD1-11.6 | Name of Alternate Coding System | Indifferent | |
| PD1-12 | Protection Indicator | Y | Value-Test Case Fixed |
| PD1-13 | Protection Indicator Effective Date | 20150625 | Presence-Content Indifferent |
| PD1-16 | Immunization Registry Status | A | Presence-Content Indifferent |
| PD1-17 | Immunization Registry Status Effective Date | 19500317 | Presence-Content Indifferent |
| PD1-18 | Publicity Code Effective Date | 20150625 | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | Value-Profile Fixed |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | 7646 | Presence-Content Indifferent |
| ORC-2.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-2.3 | Universal ID | Indifferent | |
| ORC-2.4 | Universal ID Type | Indifferent | |
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 53100 | Presence-Content Indifferent |
| ORC-3.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-3.3 | Universal ID | Indifferent | |
| ORC-3.4 | Universal ID Type | Indifferent | |
| ORC-10 | Entered By | ||
| ORC-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| ORC-10.2 | Family Name | ||
| ORC-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| ORC-10.2.2 | Own Surname Prefix | ||
| ORC-10.2.3 | Own Surname | ||
| ORC-10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-10.2.5 | Surname From Partner/Spouse | ||
| ORC-10.3 | Given Name | Lily | Presence-Content Indifferent |
| ORC-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| ORC-10.9 | Assigning Authority | ||
| ORC-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-10.9.2 | Universal ID | ||
| ORC-10.9.3 | Universal ID Type | ||
| ORC-10.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-10.12 | Check Digit Scheme | Indifferent | |
| ORC-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| ORC-12 | Ordering Provider | ||
| ORC-12.1 | ID Number | Indifferent | |
| ORC-12.2 | Family Name | ||
| ORC-12.2.1 | Surname | Indifferent | |
| ORC-12.2.2 | Own Surname Prefix | ||
| ORC-12.2.3 | Own Surname | ||
| ORC-12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-12.2.5 | Surname From Partner/Spouse | ||
| ORC-12.3 | Given Name | Indifferent | |
| ORC-12.4 | Second and Further Given Names or Initials Thereof | Indifferent | |
| ORC-12.9 | Assigning Authority | ||
| ORC-12.9.1 | Namespace ID | Indifferent | |
| ORC-12.9.2 | Universal ID | Indifferent | |
| ORC-12.9.3 | Universal ID Type | Indifferent | |
| ORC-12.10 | Name Type Code | Indifferent | |
| ORC-12.12 | Check Digit Scheme | Indifferent | |
| ORC-12.13 | Identifier Type Code | Indifferent | |
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | wcEHR | Presence-Content Indifferent |
| ORC-17.2 | Text | West Clinic | Presence-Content Indifferent |
| ORC-17.3 | Name of Coding System | HL70362 | Value-Profile Fixed |
| ORC-17.5 | Alternate Text | Indifferent | |
| ORC-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | Value-Profile Fixed |
| RXA-2 | Administration Sub-ID Counter | 1 | Value-Profile Fixed |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20150317 | Presence-Content Indifferent |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 121 | Value-Test Case Fixed |
| RXA-5.2 | Text | zoster | Presence-Content Indifferent |
| RXA-5.3 | Name of Coding System | CVX | Value-Test Case Fixed |
| RXA-5.5 | Alternate Text | Indifferent | |
| RXA-5.6 | Name of Alternate Coding System | Indifferent | |
| RXA-6 | Administered Amount | 999 | Value-Test Case Fixed |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | NonPresence | |
| RXA-7.2 | Text | NonPresence | |
| RXA-7.3 | Name of Coding System | NonPresence | |
| RXA-7.5 | Alternate Text | NonPresence | |
| RXA-7.6 | Name of Alternate Coding System | NonPresence | |
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 01 | Value-Test Case Fixed |
| RXA-9.2 | Text | Historical Administration | Presence-Content Indifferent |
| RXA-9.3 | Name of Coding System | NIP001 | Value-Profile Fixed |
| RXA-9.5 | Alternate Text | Indifferent | |
| RXA-9.6 | Name of Alternate Coding System | Indifferent | |
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | Indifferent | |
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Indifferent | |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Indifferent | |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | Indifferent | |
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | Indifferent | |
| RXA-10.9.2 | Universal ID | Indifferent | |
| RXA-10.9.3 | Universal ID Type | Indifferent | |
| RXA-10.10 | Name Type Code | Indifferent | |
| RXA-10.12 | Check Digit Scheme | Indifferent | |
| RXA-10.13 | Identifier Type Code | Indifferent | |
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | Indifferent | |
| RXA-11.4.2 | Universal ID | Indifferent | |
| RXA-11.4.3 | Universal ID Type | Indifferent | |
| RXA-15 | Substance Lot Number | Indifferent | |
| RXA-16 | Substance Expiration Date | ||
| RXA-16.1 | Time | Indifferent | |
| RXA-17 | Substance Manufacturer Name | ||
| RXA-17.1 | Identifier | Indifferent | |
| RXA-17.2 | Text | Indifferent | |
| RXA-17.3 | Name of Coding System | Indifferent | |
| RXA-17.5 | Alternate Text | Indifferent | |
| RXA-17.6 | Name of Alternate Coding System | Indifferent | |
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | Indifferent | |
| RXA-18.2 | Text | Indifferent | |
| RXA-18.3 | Name of Coding System | Indifferent | |
| RXA-18.5 | Alternate Text | Indifferent | |
| RXA-18.6 | Name of Alternate Coding System | Indifferent | |
| RXA-20 | Completion Status | CP | Value-Test Case Fixed |
| RXA-21 | Action Code - RXA | A | Value-Test Case Fixed |
| Element | Data |
|---|---|
| Patient Name | Helen Barrett |
| Mother's Maiden Name | |
| ID Number | 7120 |
| Date/Time of Birth | 03/17/1950 |
| Administrative Sex | Female |
| Patient Address | 763 Main St Bozeman MT 59715 USA |
| Local Number | (406)555-4064 |
| Helen.Barrett@isp.com | |
| Race | White |
| Ethnic Group | Not Hispanic or Latino |
| Multiple Birth Indicator | N |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 03/17/1950 |
| Publicity Code | Recall only - any method |
| Publicity Code Effective Date | 06/25/2015 |
| Protection Indicator | Yes |
| Protection Indicator Effective Date | 06/25/2015 |
| Element | Data |
|---|---|
| Administered Code | zoster |
| Date/Time Start of Administration | 03/17/2015 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical Administration |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By |
| Element | Data |
|---|---|
| Patient Name | Helen Barrett |
| Mother's Maiden Name | |
| ID Number | 7120 |
| Date/Time of Birth | 03/17/1950 |
| Administrative Sex | Female |
| Patient Address | 763 Main St Bozeman MT 59715 USA |
| Local Number | (406)555-4064 |
| Helen.Barrett@isp.com | |
| Race | White |
| Ethnic Group | Not Hispanic or Latino |
| Multiple Birth Indicator | N |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 03/17/1950 |
| Publicity Code | Recall only - any method |
| Publicity Code Effective Date | 06/25/2015 |
| Protection Indicator | Yes |
| Protection Indicator Effective Date | 06/25/2015 |
| Element | Data |
|---|---|
| Administered Code | zoster |
| Date/Time Start of Administration | 03/17/2015 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical Administration |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By |
| Description |
|---|
| The IIS has a mapping error in their CVX table and is unable to recognize the CVX code sent in RXA-5 even though it is valid. The IIS is unable to identify the appropriate vaccine, which is a required element, and rejects the message. The acknowledgement message returned contains errors for the table mapping, missing required field (RXA-5) and missing required segment (RXA). |
| Comments |
|---|
| No Comments |
| Pre Condition |
|---|
| A VXU message is generated by the EHR. |
| Post Condition |
|---|
| No PostCondition |
| Test Objectives |
|---|
| Evaluation Criteria |
|---|
| The errors returned in the ACK message must be visible in the EHR. |
| Notes for Testers |
|---|
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | iisApp | Presence-Content Indifferent |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | IIS | Presence-Content Indifferent |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | wcApp | Presence-Content Indifferent |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150625121047.853-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | ACK | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | ACK | Value-Profile Fixed |
| MSH-10 | Message Control ID | 20428 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z23 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | IIS | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | Indifferent | |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | Indifferent | |
| MSH-22.10 | Organization Identifier | Indifferent | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | wcEHR | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | Indifferent | |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | Indifferent | |
| MSH-23.10 | Organization Identifier | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA-1 | Acknowledgment Code | AE | Value-Test Case Fixed |
| MSA-2 | Message Control ID | 35560 | Presence-System Generated |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ERR-2 | Error Location | ||
| ERR-2.1 | Segment ID | RXA | Value-Test Case Fixed |
| ERR-2.2 | Segment Sequence | 1 | Value-Test Case Fixed |
| ERR-2.3 | Field Position | 5 | Value-Test Case Fixed |
| ERR-2.4 | Field Repetition | 1 | Value-Test Case Fixed |
| ERR-2.5 | Component Number | 1 | Value-Test Case Fixed List |
| ERR-2.6 | Sub-Component Number | Indifferent | |
| ERR-3 | HL7 Error Code | ||
| ERR-3.1 | Identifier | 999 | Value-Test Case Fixed |
| ERR-3.2 | Text | Application error | Presence-Content Indifferent |
| ERR-3.3 | Name of Coding System | HL70357 | Value-Profile Fixed |
| ERR-3.5 | Alternate Text | Indifferent | |
| ERR-3.6 | Name of Alternate Coding System | Indifferent | |
| ERR-4 | Severity | E | Value-Test Case Fixed |
| ERR-5 | Application Error Code | ||
| ERR-5.1 | Identifier | 5 | Value-Test Case Fixed |
| ERR-5.2 | Text | Table value not found | Presence-Content Indifferent |
| ERR-5.3 | Name of Coding System | HL70533 | Value-Profile Fixed |
| ERR-5.5 | Alternate Text | Indifferent | |
| ERR-5.6 | Name of Alternate Coding System | Indifferent | |
| ERR-8 | User Message | Vaccine code not recognized - message rejected | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | iisApp | Presence-Content Indifferent |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | IIS | Presence-Content Indifferent |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | wcApp | Presence-Content Indifferent |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150625121047.853-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | ACK | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | ACK | Value-Profile Fixed |
| MSH-10 | Message Control ID | 20428 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z23 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | IIS | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | Indifferent | |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | Indifferent | |
| MSH-22.10 | Organization Identifier | Indifferent | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | wcEHR | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | Indifferent | |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | Indifferent | |
| MSH-23.10 | Organization Identifier | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA-1 | Acknowledgment Code | AE | Value-Test Case Fixed |
| MSA-2 | Message Control ID | 35560 | Presence-System Generated |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ERR-2 | Error Location | ||
| ERR-2.1 | Segment ID | RXA | Value-Test Case Fixed |
| ERR-2.2 | Segment Sequence | 1 | Value-Test Case Fixed |
| ERR-2.3 | Field Position | 5 | Value-Test Case Fixed |
| ERR-2.4 | Field Repetition | 1 | Value-Test Case Fixed |
| ERR-2.5 | Component Number | 1 | Value-Test Case Fixed List |
| ERR-2.6 | Sub-Component Number | Indifferent | |
| ERR-3 | HL7 Error Code | ||
| ERR-3.1 | Identifier | 999 | Value-Test Case Fixed |
| ERR-3.2 | Text | Application error | Presence-Content Indifferent |
| ERR-3.3 | Name of Coding System | HL70357 | Value-Profile Fixed |
| ERR-3.5 | Alternate Text | Indifferent | |
| ERR-3.6 | Name of Alternate Coding System | Indifferent | |
| ERR-4 | Severity | E | Value-Test Case Fixed |
| ERR-5 | Application Error Code | ||
| ERR-5.1 | Identifier | 5 | Value-Test Case Fixed |
| ERR-5.2 | Text | Table value not found | Presence-Content Indifferent |
| ERR-5.3 | Name of Coding System | HL70533 | Value-Profile Fixed |
| ERR-5.5 | Alternate Text | Indifferent | |
| ERR-5.6 | Name of Alternate Coding System | Indifferent | |
| ERR-8 | User Message | Vaccine code not recognized - message rejected | Presence-Content Indifferent |
| Return an Acknowledgement | |||||
|---|---|---|---|---|---|
| Test Case ID | IZ-AD-7_Historical_IIS-Error | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement (Pass/Fail) |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which an Error is returned in the message.
The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.
| Return an Acknowledgement |
|---|
|
The receiving HIT system being tested shall process the Z23 ACK error notification message correctly; the issue identified in the error notification must be made visible in the system. |
| Description |
|---|
| A patient is seen at a clinic. A new administration is recorded. The IIS is able to process the administration message but finds a soft error (warning) which it returns in the acknowledgement message. |
| Comments |
|---|
| The test case simulates the IIS issuing an acknowledgement warning due to an internal warning even though the message is valid. |
| Pre Condition |
|---|
| No PreCondition |
| Post Condition |
|---|
| The returned warning must be visible in the EHR-S. |
| Test Objectives |
|---|
| The test case targets the EHR-S capability of supporting OIDs (e.g., in MSH-3 and for assigning authorities) for administered message and assesses the ability of the EHR-S to accept an acknowledgement message with a soft error (warning) being returned by the IIS. |
| Evaluation Criteria |
|---|
| Administered Message: Validation Report with no Errors Acknowledgement Message: An indication of a warning (See Juror Document) |
| Notes for Testers |
|---|
| No Note |
| Description |
|---|
| A 1 month old female, Ashley Jennifer Broadbent, is brought to a clinic for a well child visit by her mother Ellen Broadbent (nee Layton). A clinic staff member collects basic patient demographic information including name, date of birth and sex. A clinic provider, Wilma Thomas (physician ID 654) reviews the patient's vaccination history and determines that the child requires a Hep B vaccination. The child is covered by insurance and does not qualify for all Vaccine For Children (VFC) supplied vaccines. The mother is given the Vaccine Information Sheet (VIS) to review. After reading it, she agrees that the child should receive the Hep B vaccine. She also agrees that the data should be shared once it is incorporated into the local IIS. An appropriate dose of Hep B (ENGERIX-B) is selected from the clinic's stock of privately funded vaccines. A clinician, Lily Jackson (ID 7824) prepares and administers the doses to the patient and enters the data into the EHR and transmits it to the IIS. |
| Comments |
|---|
| No Comments |
| Pre Condition |
|---|
| No PreCondition |
| Post Condition |
|---|
| No PostCondition |
| Test Objectives |
|---|
| Support of OIDs. |
| Evaluation Criteria |
|---|
| Message Validation Report. |
| Notes for Testers |
|---|
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | NIST EHR APP | Presence-Configuration |
| MSH-3.2 | Universal ID | 2.16.840.1.113883.3.72.5.22 | Presence-Configuration |
| MSH-3.3 | Universal ID Type | ISO | Value-Profile Fixed |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | NIST EHR Facility | Presence-Configuration |
| MSH-4.2 | Universal ID | 2.16.840.1.113883.3.72.5.23 | Presence-Configuration |
| MSH-4.3 | Universal ID Type | ISO | Value-Profile Fixed |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | NIST IIS APP | Presence-Content Indifferent |
| MSH-5.2 | Universal ID | 2.16.840.1.113883.3.72.5.40.1 | Indifferent |
| MSH-5.3 | Universal ID Type | ISO | Indifferent |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | NIST IIS FAC | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | 2.16.840.1.113883.3.72.5.40.2 | Indifferent |
| MSH-6.3 | Universal ID Type | ISO | Indifferent |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150625103328.757-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | VXU | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | VXU_V04 | Value-Profile Fixed |
| MSH-10 | Message Control ID | NIST-IZ-AD-8.1_Send_V04_Z22 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | ER | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | AL | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z22 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | NIST | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | NIST-AA-1 | Indifferent |
| MSH-22.6.2 | Universal ID | 2.16.840.1.113883.3.72.5.30.1 | Indifferent |
| MSH-22.6.3 | Universal ID Type | ISO | Indifferent |
| MSH-22.7 | Identifier Type Code | XX | Indifferent |
| MSH-22.10 | Organization Identifier | 100-6478 | Indifferent |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | NIST | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | NIST-AA-1 | Indifferent |
| MSH-23.6.2 | Universal ID | 2.16.840.1.113883.3.72.5.30.1 | Indifferent |
| MSH-23.6.3 | Universal ID Type | ISO | Indifferent |
| MSH-23.7 | Identifier Type Code | XX | Indifferent |
| MSH-23.10 | Organization Identifier | 100-6478 | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID-1 | Set ID - PID | 1 | Value-Profile Fixed |
| PID-3 | Patient Identifier List | ||
| PID-3.1 | ID Number | 77100 | Presence-Content Indifferent |
| PID-3.3 | Check Digit Scheme | Indifferent | |
| PID-3.4 | Assigning Authority | ||
| PID-3.4.1 | Namespace ID | NIST MPI | Presence-Content Indifferent |
| PID-3.4.2 | Universal ID | Indifferent | |
| PID-3.4.3 | Universal ID Type | Indifferent | |
| PID-3.5 | Identifier Type Code | MR | Presence-Content Indifferent |
| PID-5 | Patient Name | ||
| PID-5.1 | Family Name | ||
| PID-5.1.1 | Surname | Broadbent | Presence-Content Indifferent |
| PID-5.1.2 | Own Surname Prefix | ||
| PID-5.1.3 | Own Surname | ||
| PID-5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-5.1.5 | Surname From Partner/Spouse | ||
| PID-5.2 | Given Name | Ashley | Presence-Content Indifferent |
| PID-5.3 | Second and Further Given Names or Initials Thereof | Jennifer | Presence-Content Indifferent |
| PID-5.7 | Name Type Code | L | Presence-Content Indifferent |
| PID-6 | Mother's Maiden Name | ||
| PID-6.1 | Family Name | ||
| PID-6.1.1 | Surname | Layton | Presence-Content Indifferent |
| PID-6.1.2 | Own Surname Prefix | ||
| PID-6.1.3 | Own Surname | ||
| PID-6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-6.1.5 | Surname From Partner/Spouse | ||
| PID-6.7 | Name Type Code | M | Value-Profile Fixed |
| PID-7 | Date/Time of Birth | ||
| PID-7.1 | Time | 20150516 | Presence-Content Indifferent |
| PID-8 | Administrative Sex | F | Presence-Content Indifferent |
| PID-10 | Race | ||
| PID-10.1 | Identifier | 2054-5 | Presence-Content Indifferent |
| PID-10.2 | Text | African American | Presence-Content Indifferent |
| PID-10.3 | Name of Coding System | CDCREC | Value-Profile Fixed |
| PID-10.5 | Alternate Text | Indifferent | |
| PID-10.6 | Name of Alternate Coding System | Indifferent | |
| PID-11 | Patient Address | ||
| PID-11.1 | Street Address | ||
| PID-11.1.1 | Street or Mailing Address | 901 North 12th St | Presence-Content Indifferent |
| PID-11.1.2 | Street Name | ||
| PID-11.1.3 | Dwelling Number | ||
| PID-11.2 | Other Designation | Indifferent | |
| PID-11.3 | City | Bozeman | Presence-Content Indifferent |
| PID-11.4 | State or Province | MT | Presence-Content Indifferent |
| PID-11.5 | Zip or Postal Code | 59715 | Presence-Content Indifferent |
| PID-11.6 | Country | USA | Presence-Content Indifferent |
| PID-11.7 | Address Type | P | Presence-Content Indifferent |
| PID-13 | Phone Number - Home | ||
| PID-13.2 | Telecommunication Use Code | PRN | Presence-Content Indifferent |
| PID-13.3 | Telecommunication Equipment Type | PH | Value-Test Case Fixed |
| PID-13.4 | Email Address | NonPresence | |
| PID-13.6 | Area/City Code | 406 | Presence-Content Indifferent |
| PID-13.7 | Local Number | 5552262 | Presence-Content Indifferent |
| PID-22 | Ethnic Group | ||
| PID-22.1 | Identifier | 2186-5 | Presence-Content Indifferent |
| PID-22.2 | Text | Not Hispanic or Latino | Presence-Content Indifferent |
| PID-22.3 | Name of Coding System | CDCREC | Value-Profile Fixed |
| PID-22.5 | Alternate Text | Indifferent | |
| PID-22.6 | Name of Alternate Coding System | Indifferent | |
| PID-24 | Multiple Birth Indicator | N | Presence-Content Indifferent |
| PID-25 | Birth Order | 1 | Indifferent |
| PID-29 | Patient Death Date and Time | ||
| PID-29.1 | Time | Indifferent | |
| PID-30 | Patient Death Indicator | N | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1-11 | Publicity Code | ||
| PD1-11.1 | Identifier | 03 | Presence-Content Indifferent |
| PD1-11.2 | Text | Reminder/recall - no calls | Presence-Content Indifferent |
| PD1-11.3 | Name of Coding System | HL70215 | Value-Profile Fixed |
| PD1-11.5 | Alternate Text | Indifferent | |
| PD1-11.6 | Name of Alternate Coding System | Indifferent | |
| PD1-12 | Protection Indicator | N | Value-Test Case Fixed |
| PD1-13 | Protection Indicator Effective Date | 20150625 | Presence-Content Indifferent |
| PD1-16 | Immunization Registry Status | A | Presence-Content Indifferent |
| PD1-17 | Immunization Registry Status Effective Date | 20150516 | Presence-Content Indifferent |
| PD1-18 | Publicity Code Effective Date | 20150625 | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| NK1-1 | Set ID - NK1 | 1 | Value-Profile Fixed |
| NK1-2 | Name | ||
| NK1-2.1 | Family Name | ||
| NK1-2.1.1 | Surname | Broadbent | Presence-Content Indifferent |
| NK1-2.1.2 | Own Surname Prefix | ||
| NK1-2.1.3 | Own Surname | ||
| NK1-2.1.4 | Surname Prefix From Partner/Spouse | ||
| NK1-2.1.5 | Surname From Partner/Spouse | ||
| NK1-2.2 | Given Name | Ellen | Presence-Content Indifferent |
| NK1-2.3 | Second and Further Given Names or Initials Thereof | Indifferent | |
| NK1-2.7 | Name Type Code | L | Presence-Content Indifferent |
| NK1-3 | Relationship | ||
| NK1-3.1 | Identifier | MTH | Presence-Content Indifferent |
| NK1-3.2 | Text | Mother | Presence-Content Indifferent |
| NK1-3.3 | Name of Coding System | HL70063 | Value-Profile Fixed |
| NK1-3.5 | Alternate Text | Indifferent | |
| NK1-3.6 | Name of Alternate Coding System | Indifferent | |
| NK1-4 | Address | ||
| NK1-4.1 | Street Address | ||
| NK1-4.1.1 | Street or Mailing Address | 901 North 12th St | Presence-Content Indifferent |
| NK1-4.1.2 | Street Name | ||
| NK1-4.1.3 | Dwelling Number | ||
| NK1-4.2 | Other Designation | Indifferent | |
| NK1-4.3 | City | Bozeman | Presence-Content Indifferent |
| NK1-4.4 | State or Province | MT | Presence-Content Indifferent |
| NK1-4.5 | Zip or Postal Code | 59715 | Presence-Content Indifferent |
| NK1-4.6 | Country | USA | Presence-Content Indifferent |
| NK1-4.7 | Address Type | P | Presence-Content Indifferent |
| NK1-5 | Phone Number | ||
| NK1-5.2 | Telecommunication Use Code | PRN | Presence-Content Indifferent |
| NK1-5.3 | Telecommunication Equipment Type | PH | Value-Test Case Fixed |
| NK1-5.4 | Email Address | NonPresence | |
| NK1-5.6 | Area/City Code | 406 | Presence-Content Indifferent |
| NK1-5.7 | Local Number | 5552262 | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | Value-Profile Fixed |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | 3881 | Presence-Content Indifferent |
| ORC-2.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-2.3 | Universal ID | Indifferent | |
| ORC-2.4 | Universal ID Type | Indifferent | |
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 13926 | Presence-Content Indifferent |
| ORC-3.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-3.3 | Universal ID | Indifferent | |
| ORC-3.4 | Universal ID Type | Indifferent | |
| ORC-10 | Entered By | ||
| ORC-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| ORC-10.2 | Family Name | ||
| ORC-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| ORC-10.2.2 | Own Surname Prefix | ||
| ORC-10.2.3 | Own Surname | ||
| ORC-10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-10.2.5 | Surname From Partner/Spouse | ||
| ORC-10.3 | Given Name | Lily | Presence-Content Indifferent |
| ORC-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| ORC-10.9 | Assigning Authority | ||
| ORC-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-10.9.2 | Universal ID | ||
| ORC-10.9.3 | Universal ID Type | ||
| ORC-10.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-10.12 | Check Digit Scheme | Indifferent | |
| ORC-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| ORC-12 | Ordering Provider | ||
| ORC-12.1 | ID Number | 654 | Presence-Content Indifferent |
| ORC-12.2 | Family Name | ||
| ORC-12.2.1 | Surname | Thomas | Presence-Content Indifferent |
| ORC-12.2.2 | Own Surname Prefix | ||
| ORC-12.2.3 | Own Surname | ||
| ORC-12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-12.2.5 | Surname From Partner/Spouse | ||
| ORC-12.3 | Given Name | Wilma | Presence-Content Indifferent |
| ORC-12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | Presence-Content Indifferent |
| ORC-12.9 | Assigning Authority | ||
| ORC-12.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-12.9.2 | Universal ID | ||
| ORC-12.9.3 | Universal ID Type | ||
| ORC-12.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-12.12 | Check Digit Scheme | Indifferent | |
| ORC-12.13 | Identifier Type Code | MD | Presence-Content Indifferent |
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | wcEHR | Presence-Content Indifferent |
| ORC-17.2 | Text | West Clinic | Presence-Content Indifferent |
| ORC-17.3 | Name of Coding System | HL70362 | Value-Profile Fixed |
| ORC-17.5 | Alternate Text | Indifferent | |
| ORC-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | Value-Profile Fixed |
| RXA-2 | Administration Sub-ID Counter | 1 | Value-Profile Fixed |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20150625 | Presence-Content Indifferent |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 58160-0820-01 | Value-Test Case Fixed |
| RXA-5.2 | Text | ENGERIX-B | Presence-Content Indifferent |
| RXA-5.3 | Name of Coding System | NDC | Value-Test Case Fixed |
| RXA-5.5 | Alternate Text | Indifferent | |
| RXA-5.6 | Name of Alternate Coding System | Indifferent | |
| RXA-6 | Administered Amount | 0.5 | Value-Test Case Fixed |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | mL | Value-Test Case Fixed |
| RXA-7.2 | Text | mL | Presence-Content Indifferent |
| RXA-7.3 | Name of Coding System | UCUM | Value-Test Case Fixed |
| RXA-7.5 | Alternate Text | Indifferent | |
| RXA-7.6 | Name of Alternate Coding System | Indifferent | |
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 00 | Value-Test Case Fixed |
| RXA-9.2 | Text | New Record | Presence-Content Indifferent |
| RXA-9.3 | Name of Coding System | NIP001 | Value-Profile Fixed |
| RXA-9.5 | Alternate Text | Indifferent | |
| RXA-9.6 | Name of Alternate Coding System | Indifferent | |
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Lily | Presence-Content Indifferent |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | L | Presence-Content Indifferent |
| RXA-10.12 | Check Digit Scheme | Indifferent | |
| RXA-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-11.4.2 | Universal ID | Indifferent | |
| RXA-11.4.3 | Universal ID Type | Indifferent | |
| RXA-15 | Substance Lot Number | 797397 | Presence-Content Indifferent |
| RXA-16 | Substance Expiration Date | ||
| RXA-16.1 | Time | 20151203 | Presence-Content Indifferent |
| RXA-17 | Substance Manufacturer Name | ||
| RXA-17.1 | Identifier | SKB | Presence-Content Indifferent |
| RXA-17.2 | Text | GlaxoSmithKline | Presence-Content Indifferent |
| RXA-17.3 | Name of Coding System | MVX | Value-Test Case Fixed |
| RXA-17.5 | Alternate Text | Indifferent | |
| RXA-17.6 | Name of Alternate Coding System | Indifferent | |
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | Indifferent | |
| RXA-18.2 | Text | Indifferent | |
| RXA-18.3 | Name of Coding System | Indifferent | |
| RXA-18.5 | Alternate Text | Indifferent | |
| RXA-18.6 | Name of Alternate Coding System | Indifferent | |
| RXA-20 | Completion Status | CP | Value-Test Case Fixed |
| RXA-21 | Action Code - RXA | A | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR-1 | Route | ||
| RXR-1.1 | Identifier | C28161 | Presence-Content Indifferent |
| RXR-1.2 | Text | Intramuscular | Presence-Content Indifferent |
| RXR-1.3 | Name of Coding System | NCIT | Value-Profile Fixed |
| RXR-1.5 | Alternate Text | Indifferent | |
| RXR-1.6 | Name of Alternate Coding System | Indifferent | |
| RXR-2 | Administration Site | ||
| RXR-2.1 | Identifier | LT | Presence-Content Indifferent |
| RXR-2.2 | Text | Left Thigh | Presence-Content Indifferent |
| RXR-2.3 | Name of Coding System | HL70163 | Value-Profile Fixed |
| RXR-2.5 | Alternate Text | Indifferent | |
| RXR-2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 1 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30963-3 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Source | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 1 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-5.1 | Identifier | PHC70 | |
| OBX-5.2 | Text | Private | |
| OBX-5.3 | Name of Coding System | CDCPHINVS | |
| OBX-5.5 | Alternate Text | ||
| OBX-5.6 | Name of Alternate Coding System | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150625 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 2 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 64994-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Program Eligibility | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 2 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-5.1 | Identifier | V01 | |
| OBX-5.2 | Text | Not VFC Eligible | |
| OBX-5.3 | Name of Coding System | HL70064 | |
| OBX-5.5 | Alternate Text | ||
| OBX-5.6 | Name of Alternate Coding System | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150625 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | VXC40 | Value-Test Case Fixed |
| OBX-17.2 | Text | per immunization | Presence-Content Indifferent |
| OBX-17.3 | Name of Coding System | CDCPHINVS | Value-Profile Fixed |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 3 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 69764-9 | Value-Test Case Fixed |
| OBX-3.2 | Text | Document Type | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-5.1 | Identifier | 253088698300005911120202 | |
| OBX-5.2 | Text | Hepatitis B VIS | |
| OBX-5.3 | Name of Coding System | cdcgs1vis | |
| OBX-5.5 | Alternate Text | ||
| OBX-5.6 | Name of Alternate Coding System | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150625 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 4 | Value-Profile Fixed |
| OBX-2 | Value Type | DT | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 29769-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Date Vis Presented | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | 20150625 | Presence-Content Indifferent |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150625 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | NIST EHR APP | Presence-Configuration |
| MSH-3.2 | Universal ID | 2.16.840.1.113883.3.72.5.22 | Presence-Configuration |
| MSH-3.3 | Universal ID Type | ISO | Value-Profile Fixed |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | NIST EHR Facility | Presence-Configuration |
| MSH-4.2 | Universal ID | 2.16.840.1.113883.3.72.5.23 | Presence-Configuration |
| MSH-4.3 | Universal ID Type | ISO | Value-Profile Fixed |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | NIST IIS APP | Presence-Content Indifferent |
| MSH-5.2 | Universal ID | 2.16.840.1.113883.3.72.5.40.1 | Indifferent |
| MSH-5.3 | Universal ID Type | ISO | Indifferent |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | NIST IIS FAC | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | 2.16.840.1.113883.3.72.5.40.2 | Indifferent |
| MSH-6.3 | Universal ID Type | ISO | Indifferent |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150625103328.757-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | VXU | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | VXU_V04 | Value-Profile Fixed |
| MSH-10 | Message Control ID | NIST-IZ-AD-8.1_Send_V04_Z22 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | ER | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | AL | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z22 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | NIST | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | NIST-AA-1 | Indifferent |
| MSH-22.6.2 | Universal ID | 2.16.840.1.113883.3.72.5.30.1 | Indifferent |
| MSH-22.6.3 | Universal ID Type | ISO | Indifferent |
| MSH-22.7 | Identifier Type Code | XX | Indifferent |
| MSH-22.10 | Organization Identifier | 100-6478 | Indifferent |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | NIST | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | NIST-AA-1 | Indifferent |
| MSH-23.6.2 | Universal ID | 2.16.840.1.113883.3.72.5.30.1 | Indifferent |
| MSH-23.6.3 | Universal ID Type | ISO | Indifferent |
| MSH-23.7 | Identifier Type Code | XX | Indifferent |
| MSH-23.10 | Organization Identifier | 100-6478 | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID-1 | Set ID - PID | 1 | Value-Profile Fixed |
| PID-3 | Patient Identifier List | ||
| PID-3.1 | ID Number | 77100 | Presence-Content Indifferent |
| PID-3.3 | Check Digit Scheme | Indifferent | |
| PID-3.4 | Assigning Authority | ||
| PID-3.4.1 | Namespace ID | NIST MPI | Presence-Content Indifferent |
| PID-3.4.2 | Universal ID | Indifferent | |
| PID-3.4.3 | Universal ID Type | Indifferent | |
| PID-3.5 | Identifier Type Code | MR | Presence-Content Indifferent |
| PID-5 | Patient Name | ||
| PID-5.1 | Family Name | ||
| PID-5.1.1 | Surname | Broadbent | Presence-Content Indifferent |
| PID-5.1.2 | Own Surname Prefix | ||
| PID-5.1.3 | Own Surname | ||
| PID-5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-5.1.5 | Surname From Partner/Spouse | ||
| PID-5.2 | Given Name | Ashley | Presence-Content Indifferent |
| PID-5.3 | Second and Further Given Names or Initials Thereof | Jennifer | Presence-Content Indifferent |
| PID-5.7 | Name Type Code | L | Presence-Content Indifferent |
| PID-6 | Mother's Maiden Name | ||
| PID-6.1 | Family Name | ||
| PID-6.1.1 | Surname | Layton | Presence-Content Indifferent |
| PID-6.1.2 | Own Surname Prefix | ||
| PID-6.1.3 | Own Surname | ||
| PID-6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-6.1.5 | Surname From Partner/Spouse | ||
| PID-6.7 | Name Type Code | M | Value-Profile Fixed |
| PID-7 | Date/Time of Birth | ||
| PID-7.1 | Time | 20150516 | Presence-Content Indifferent |
| PID-8 | Administrative Sex | F | Presence-Content Indifferent |
| PID-10 | Race | ||
| PID-10.1 | Identifier | 2054-5 | Presence-Content Indifferent |
| PID-10.2 | Text | African American | Presence-Content Indifferent |
| PID-10.3 | Name of Coding System | CDCREC | Value-Profile Fixed |
| PID-10.5 | Alternate Text | Indifferent | |
| PID-10.6 | Name of Alternate Coding System | Indifferent | |
| PID-11 | Patient Address | ||
| PID-11.1 | Street Address | ||
| PID-11.1.1 | Street or Mailing Address | 901 North 12th St | Presence-Content Indifferent |
| PID-11.1.2 | Street Name | ||
| PID-11.1.3 | Dwelling Number | ||
| PID-11.2 | Other Designation | Indifferent | |
| PID-11.3 | City | Bozeman | Presence-Content Indifferent |
| PID-11.4 | State or Province | MT | Presence-Content Indifferent |
| PID-11.5 | Zip or Postal Code | 59715 | Presence-Content Indifferent |
| PID-11.6 | Country | USA | Presence-Content Indifferent |
| PID-11.7 | Address Type | P | Presence-Content Indifferent |
| PID-13 | Phone Number - Home | ||
| PID-13.2 | Telecommunication Use Code | PRN | Presence-Content Indifferent |
| PID-13.3 | Telecommunication Equipment Type | PH | Value-Test Case Fixed |
| PID-13.4 | Email Address | NonPresence | |
| PID-13.6 | Area/City Code | 406 | Presence-Content Indifferent |
| PID-13.7 | Local Number | 5552262 | Presence-Content Indifferent |
| PID-22 | Ethnic Group | ||
| PID-22.1 | Identifier | 2186-5 | Presence-Content Indifferent |
| PID-22.2 | Text | Not Hispanic or Latino | Presence-Content Indifferent |
| PID-22.3 | Name of Coding System | CDCREC | Value-Profile Fixed |
| PID-22.5 | Alternate Text | Indifferent | |
| PID-22.6 | Name of Alternate Coding System | Indifferent | |
| PID-24 | Multiple Birth Indicator | N | Presence-Content Indifferent |
| PID-25 | Birth Order | 1 | Indifferent |
| PID-29 | Patient Death Date and Time | ||
| PID-29.1 | Time | Indifferent | |
| PID-30 | Patient Death Indicator | N | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1-11 | Publicity Code | ||
| PD1-11.1 | Identifier | 03 | Presence-Content Indifferent |
| PD1-11.2 | Text | Reminder/recall - no calls | Presence-Content Indifferent |
| PD1-11.3 | Name of Coding System | HL70215 | Value-Profile Fixed |
| PD1-11.5 | Alternate Text | Indifferent | |
| PD1-11.6 | Name of Alternate Coding System | Indifferent | |
| PD1-12 | Protection Indicator | N | Value-Test Case Fixed |
| PD1-13 | Protection Indicator Effective Date | 20150625 | Presence-Content Indifferent |
| PD1-16 | Immunization Registry Status | A | Presence-Content Indifferent |
| PD1-17 | Immunization Registry Status Effective Date | 20150516 | Presence-Content Indifferent |
| PD1-18 | Publicity Code Effective Date | 20150625 | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| NK1-1 | Set ID - NK1 | 1 | Value-Profile Fixed |
| NK1-2 | Name | ||
| NK1-2.1 | Family Name | ||
| NK1-2.1.1 | Surname | Broadbent | Presence-Content Indifferent |
| NK1-2.1.2 | Own Surname Prefix | ||
| NK1-2.1.3 | Own Surname | ||
| NK1-2.1.4 | Surname Prefix From Partner/Spouse | ||
| NK1-2.1.5 | Surname From Partner/Spouse | ||
| NK1-2.2 | Given Name | Ellen | Presence-Content Indifferent |
| NK1-2.3 | Second and Further Given Names or Initials Thereof | Indifferent | |
| NK1-2.7 | Name Type Code | L | Presence-Content Indifferent |
| NK1-3 | Relationship | ||
| NK1-3.1 | Identifier | MTH | Presence-Content Indifferent |
| NK1-3.2 | Text | Mother | Presence-Content Indifferent |
| NK1-3.3 | Name of Coding System | HL70063 | Value-Profile Fixed |
| NK1-3.5 | Alternate Text | Indifferent | |
| NK1-3.6 | Name of Alternate Coding System | Indifferent | |
| NK1-4 | Address | ||
| NK1-4.1 | Street Address | ||
| NK1-4.1.1 | Street or Mailing Address | 901 North 12th St | Presence-Content Indifferent |
| NK1-4.1.2 | Street Name | ||
| NK1-4.1.3 | Dwelling Number | ||
| NK1-4.2 | Other Designation | Indifferent | |
| NK1-4.3 | City | Bozeman | Presence-Content Indifferent |
| NK1-4.4 | State or Province | MT | Presence-Content Indifferent |
| NK1-4.5 | Zip or Postal Code | 59715 | Presence-Content Indifferent |
| NK1-4.6 | Country | USA | Presence-Content Indifferent |
| NK1-4.7 | Address Type | P | Presence-Content Indifferent |
| NK1-5 | Phone Number | ||
| NK1-5.2 | Telecommunication Use Code | PRN | Presence-Content Indifferent |
| NK1-5.3 | Telecommunication Equipment Type | PH | Value-Test Case Fixed |
| NK1-5.4 | Email Address | NonPresence | |
| NK1-5.6 | Area/City Code | 406 | Presence-Content Indifferent |
| NK1-5.7 | Local Number | 5552262 | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | Value-Profile Fixed |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | 3881 | Presence-Content Indifferent |
| ORC-2.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-2.3 | Universal ID | Indifferent | |
| ORC-2.4 | Universal ID Type | Indifferent | |
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 13926 | Presence-Content Indifferent |
| ORC-3.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-3.3 | Universal ID | Indifferent | |
| ORC-3.4 | Universal ID Type | Indifferent | |
| ORC-10 | Entered By | ||
| ORC-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| ORC-10.2 | Family Name | ||
| ORC-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| ORC-10.2.2 | Own Surname Prefix | ||
| ORC-10.2.3 | Own Surname | ||
| ORC-10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-10.2.5 | Surname From Partner/Spouse | ||
| ORC-10.3 | Given Name | Lily | Presence-Content Indifferent |
| ORC-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| ORC-10.9 | Assigning Authority | ||
| ORC-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-10.9.2 | Universal ID | ||
| ORC-10.9.3 | Universal ID Type | ||
| ORC-10.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-10.12 | Check Digit Scheme | Indifferent | |
| ORC-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| ORC-12 | Ordering Provider | ||
| ORC-12.1 | ID Number | 654 | Presence-Content Indifferent |
| ORC-12.2 | Family Name | ||
| ORC-12.2.1 | Surname | Thomas | Presence-Content Indifferent |
| ORC-12.2.2 | Own Surname Prefix | ||
| ORC-12.2.3 | Own Surname | ||
| ORC-12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-12.2.5 | Surname From Partner/Spouse | ||
| ORC-12.3 | Given Name | Wilma | Presence-Content Indifferent |
| ORC-12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | Presence-Content Indifferent |
| ORC-12.9 | Assigning Authority | ||
| ORC-12.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-12.9.2 | Universal ID | ||
| ORC-12.9.3 | Universal ID Type | ||
| ORC-12.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-12.12 | Check Digit Scheme | Indifferent | |
| ORC-12.13 | Identifier Type Code | MD | Presence-Content Indifferent |
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | wcEHR | Presence-Content Indifferent |
| ORC-17.2 | Text | West Clinic | Presence-Content Indifferent |
| ORC-17.3 | Name of Coding System | HL70362 | Value-Profile Fixed |
| ORC-17.5 | Alternate Text | Indifferent | |
| ORC-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | Value-Profile Fixed |
| RXA-2 | Administration Sub-ID Counter | 1 | Value-Profile Fixed |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20150625 | Presence-Content Indifferent |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 58160-0820-01 | Value-Test Case Fixed |
| RXA-5.2 | Text | ENGERIX-B | Presence-Content Indifferent |
| RXA-5.3 | Name of Coding System | NDC | Value-Test Case Fixed |
| RXA-5.5 | Alternate Text | Indifferent | |
| RXA-5.6 | Name of Alternate Coding System | Indifferent | |
| RXA-6 | Administered Amount | 0.5 | Value-Test Case Fixed |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | mL | Value-Test Case Fixed |
| RXA-7.2 | Text | mL | Presence-Content Indifferent |
| RXA-7.3 | Name of Coding System | UCUM | Value-Test Case Fixed |
| RXA-7.5 | Alternate Text | Indifferent | |
| RXA-7.6 | Name of Alternate Coding System | Indifferent | |
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 00 | Value-Test Case Fixed |
| RXA-9.2 | Text | New Record | Presence-Content Indifferent |
| RXA-9.3 | Name of Coding System | NIP001 | Value-Profile Fixed |
| RXA-9.5 | Alternate Text | Indifferent | |
| RXA-9.6 | Name of Alternate Coding System | Indifferent | |
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Lily | Presence-Content Indifferent |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | L | Presence-Content Indifferent |
| RXA-10.12 | Check Digit Scheme | Indifferent | |
| RXA-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-11.4.2 | Universal ID | Indifferent | |
| RXA-11.4.3 | Universal ID Type | Indifferent | |
| RXA-15 | Substance Lot Number | 797397 | Presence-Content Indifferent |
| RXA-16 | Substance Expiration Date | ||
| RXA-16.1 | Time | 20151203 | Presence-Content Indifferent |
| RXA-17 | Substance Manufacturer Name | ||
| RXA-17.1 | Identifier | SKB | Presence-Content Indifferent |
| RXA-17.2 | Text | GlaxoSmithKline | Presence-Content Indifferent |
| RXA-17.3 | Name of Coding System | MVX | Value-Test Case Fixed |
| RXA-17.5 | Alternate Text | Indifferent | |
| RXA-17.6 | Name of Alternate Coding System | Indifferent | |
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | Indifferent | |
| RXA-18.2 | Text | Indifferent | |
| RXA-18.3 | Name of Coding System | Indifferent | |
| RXA-18.5 | Alternate Text | Indifferent | |
| RXA-18.6 | Name of Alternate Coding System | Indifferent | |
| RXA-20 | Completion Status | CP | Value-Test Case Fixed |
| RXA-21 | Action Code - RXA | A | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR-1 | Route | ||
| RXR-1.1 | Identifier | C28161 | Presence-Content Indifferent |
| RXR-1.2 | Text | Intramuscular | Presence-Content Indifferent |
| RXR-1.3 | Name of Coding System | NCIT | Value-Profile Fixed |
| RXR-1.5 | Alternate Text | Indifferent | |
| RXR-1.6 | Name of Alternate Coding System | Indifferent | |
| RXR-2 | Administration Site | ||
| RXR-2.1 | Identifier | LT | Presence-Content Indifferent |
| RXR-2.2 | Text | Left Thigh | Presence-Content Indifferent |
| RXR-2.3 | Name of Coding System | HL70163 | Value-Profile Fixed |
| RXR-2.5 | Alternate Text | Indifferent | |
| RXR-2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 1 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30963-3 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Source | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 1 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-5.1 | Identifier | PHC70 | |
| OBX-5.2 | Text | Private | |
| OBX-5.3 | Name of Coding System | CDCPHINVS | |
| OBX-5.5 | Alternate Text | ||
| OBX-5.6 | Name of Alternate Coding System | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150625 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 2 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 64994-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Program Eligibility | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 2 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-5.1 | Identifier | V01 | |
| OBX-5.2 | Text | Not VFC Eligible | |
| OBX-5.3 | Name of Coding System | HL70064 | |
| OBX-5.5 | Alternate Text | ||
| OBX-5.6 | Name of Alternate Coding System | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150625 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | VXC40 | Value-Test Case Fixed |
| OBX-17.2 | Text | per immunization | Presence-Content Indifferent |
| OBX-17.3 | Name of Coding System | CDCPHINVS | Value-Profile Fixed |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 3 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 69764-9 | Value-Test Case Fixed |
| OBX-3.2 | Text | Document Type | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-5.1 | Identifier | 253088698300005911120202 | |
| OBX-5.2 | Text | Hepatitis B VIS | |
| OBX-5.3 | Name of Coding System | cdcgs1vis | |
| OBX-5.5 | Alternate Text | ||
| OBX-5.6 | Name of Alternate Coding System | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150625 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 4 | Value-Profile Fixed |
| OBX-2 | Value Type | DT | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 29769-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Date Vis Presented | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | 20150625 | Presence-Content Indifferent |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150625 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Element | Data |
|---|---|
| Patient Name | Ashley Jennifer Broadbent |
| Mother's Maiden Name | Layton |
| ID Number | 77100 |
| Date/Time of Birth | 05/16/2015 |
| Administrative Sex | Female |
| Patient Address | 901 North 12th St Bozeman MT 59715 USA |
| Local Number | (406)555-2262 |
| Race | African American |
| Ethnic Group | Not Hispanic or Latino |
| Multiple Birth Indicator | N |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 05/16/2015 |
| Publicity Code | Reminder/recall - no calls |
| Publicity Code Effective Date | 06/25/2015 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 06/25/2015 |
| Element | Data |
|---|---|
| Name | Ellen Broadbent |
| Relationship | Mother |
| Address | 901 North 12th St Bozeman MT 59715 USA |
| Phone Number | (406)555-2262 |
| Element | Data |
|---|---|
| Administered Code | ENGERIX-B |
| Date/Time Start of Administration | 06/25/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 797397 |
| Substance Expiration Date | 12/03/2015 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Thigh |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Private |
| Vaccine Funding Program Eligibility | Not VFC Eligible |
| Document Type | Hepatitis B VIS |
| Date Vis Presented | 06/25/2015 |
| Element | Data |
|---|---|
| Patient Name | Ashley Jennifer Broadbent |
| Mother's Maiden Name | Layton |
| ID Number | 77100 |
| Date/Time of Birth | 05/16/2015 |
| Administrative Sex | Female |
| Patient Address | 901 North 12th St Bozeman MT 59715 USA |
| Local Number | (406)555-2262 |
| Race | African American |
| Ethnic Group | Not Hispanic or Latino |
| Multiple Birth Indicator | N |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 05/16/2015 |
| Publicity Code | Reminder/recall - no calls |
| Publicity Code Effective Date | 06/25/2015 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 06/25/2015 |
| Element | Data |
|---|---|
| Name | Ellen Broadbent |
| Relationship | Mother |
| Address | 901 North 12th St Bozeman MT 59715 USA |
| Phone Number | (406)555-2262 |
| Element | Data |
|---|---|
| Administered Code | ENGERIX-B |
| Date/Time Start of Administration | 06/25/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 797397 |
| Substance Expiration Date | 12/03/2015 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Thigh |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Private |
| Vaccine Funding Program Eligibility | Not VFC Eligible |
| Document Type | Hepatitis B VIS |
| Date Vis Presented | 06/25/2015 |
| Description |
|---|
| A mapping error in the IIS software results in the IIS being unable to recognize the administration site sent in RXR-2 even though it is valid. The acknowledgement message returned contains a warning for an invalid value. |
| Comments |
|---|
| No Comments |
| Pre Condition |
|---|
| A VXU message is generated by the EHR. |
| Post Condition |
|---|
| No PostCondition |
| Test Objectives |
|---|
| Evaluation Criteria |
|---|
| The warning returned in the acknowledgement message is visible in the system responsible for the content of the administration message. |
| Notes for Testers |
|---|
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | NIST IIS APP | Presence-Content Indifferent |
| MSH-3.2 | Universal ID | 2.16.840.1.113883.3.72.5.40.1 | Indifferent |
| MSH-3.3 | Universal ID Type | ISO | Indifferent |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | NIST IIS FAC | Presence-Content Indifferent |
| MSH-4.2 | Universal ID | 2.16.840.1.113883.3.72.5.40.2 | Indifferent |
| MSH-4.3 | Universal ID Type | ISO | Indifferent |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | NIST EHR APP | Presence-Content Indifferent |
| MSH-5.2 | Universal ID | 2.16.840.1.113883.3.72.5.22 | Indifferent |
| MSH-5.3 | Universal ID Type | ISO | Indifferent |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | NIST EHR Facility | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | 2.16.840.1.113883.3.72.5.23 | Indifferent |
| MSH-6.3 | Universal ID Type | ISO | Indifferent |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150625103328.758-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | ACK | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | ACK | Value-Profile Fixed |
| MSH-10 | Message Control ID | 23842 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z23 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | NIST IIS FAC | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | NIST-AA-1 | Indifferent |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | XX | Indifferent |
| MSH-22.10 | Organization Identifier | 100-1776 | Indifferent |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | NIST EHR Facility | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | NIST-AA-1 | Indifferent |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | XX | Indifferent |
| MSH-23.10 | Organization Identifier | 100-6482 | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA-1 | Acknowledgment Code | AE | Value-Test Case Fixed |
| MSA-2 | Message Control ID | NIST-IZ-AD-8.1_Send_V04_Z22 | Presence-System Generated |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ERR-2 | Error Location | ||
| ERR-2.1 | Segment ID | RXR | Value-Test Case Fixed |
| ERR-2.2 | Segment Sequence | 2 | Value-Test Case Fixed |
| ERR-2.3 | Field Position | 1 | Value-Test Case Fixed |
| ERR-2.4 | Field Repetition | 1 | Value-Test Case Fixed |
| ERR-2.5 | Component Number | 1 | Value-Test Case Fixed |
| ERR-2.6 | Sub-Component Number | Indifferent | |
| ERR-3 | HL7 Error Code | ||
| ERR-3.1 | Identifier | 999 | Value-Test Case Fixed |
| ERR-3.2 | Text | Application error | Presence-Content Indifferent |
| ERR-3.3 | Name of Coding System | HL70357 | Value-Profile Fixed |
| ERR-3.5 | Alternate Text | Indifferent | |
| ERR-3.6 | Name of Alternate Coding System | Indifferent | |
| ERR-4 | Severity | W | Value-Test Case Fixed |
| ERR-5 | Application Error Code | ||
| ERR-5.1 | Identifier | 5 | Value-Test Case Fixed |
| ERR-5.2 | Text | Table value not found | Presence-Content Indifferent |
| ERR-5.3 | Name of Coding System | HL70533 | Value-Profile Fixed |
| ERR-5.5 | Alternate Text | Indifferent | |
| ERR-5.6 | Name of Alternate Coding System | Indifferent | |
| ERR-8 | User Message | Administration Site not recognized - site data will not be saved | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | NIST IIS APP | Presence-Content Indifferent |
| MSH-3.2 | Universal ID | 2.16.840.1.113883.3.72.5.40.1 | Indifferent |
| MSH-3.3 | Universal ID Type | ISO | Indifferent |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | NIST IIS FAC | Presence-Content Indifferent |
| MSH-4.2 | Universal ID | 2.16.840.1.113883.3.72.5.40.2 | Indifferent |
| MSH-4.3 | Universal ID Type | ISO | Indifferent |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | NIST EHR APP | Presence-Content Indifferent |
| MSH-5.2 | Universal ID | 2.16.840.1.113883.3.72.5.22 | Indifferent |
| MSH-5.3 | Universal ID Type | ISO | Indifferent |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | NIST EHR Facility | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | 2.16.840.1.113883.3.72.5.23 | Indifferent |
| MSH-6.3 | Universal ID Type | ISO | Indifferent |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150625103328.758-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | ACK | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | ACK | Value-Profile Fixed |
| MSH-10 | Message Control ID | 23842 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z23 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | NIST IIS FAC | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | NIST-AA-1 | Indifferent |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | XX | Indifferent |
| MSH-22.10 | Organization Identifier | 100-1776 | Indifferent |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | NIST EHR Facility | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | NIST-AA-1 | Indifferent |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | XX | Indifferent |
| MSH-23.10 | Organization Identifier | 100-6482 | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA-1 | Acknowledgment Code | AE | Value-Test Case Fixed |
| MSA-2 | Message Control ID | NIST-IZ-AD-8.1_Send_V04_Z22 | Presence-System Generated |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ERR-2 | Error Location | ||
| ERR-2.1 | Segment ID | RXR | Value-Test Case Fixed |
| ERR-2.2 | Segment Sequence | 2 | Value-Test Case Fixed |
| ERR-2.3 | Field Position | 1 | Value-Test Case Fixed |
| ERR-2.4 | Field Repetition | 1 | Value-Test Case Fixed |
| ERR-2.5 | Component Number | 1 | Value-Test Case Fixed |
| ERR-2.6 | Sub-Component Number | Indifferent | |
| ERR-3 | HL7 Error Code | ||
| ERR-3.1 | Identifier | 999 | Value-Test Case Fixed |
| ERR-3.2 | Text | Application error | Presence-Content Indifferent |
| ERR-3.3 | Name of Coding System | HL70357 | Value-Profile Fixed |
| ERR-3.5 | Alternate Text | Indifferent | |
| ERR-3.6 | Name of Alternate Coding System | Indifferent | |
| ERR-4 | Severity | W | Value-Test Case Fixed |
| ERR-5 | Application Error Code | ||
| ERR-5.1 | Identifier | 5 | Value-Test Case Fixed |
| ERR-5.2 | Text | Table value not found | Presence-Content Indifferent |
| ERR-5.3 | Name of Coding System | HL70533 | Value-Profile Fixed |
| ERR-5.5 | Alternate Text | Indifferent | |
| ERR-5.6 | Name of Alternate Coding System | Indifferent | |
| ERR-8 | User Message | Administration Site not recognized - site data will not be saved | Presence-Content Indifferent |
| Return an Acknowledgement | |||||
|---|---|---|---|---|---|
| Test Case ID | IZ-AD-8_Admin_IIS-Warning | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement (Pass/Fail) |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which an Error is returned in the message.
The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.
| Return an Acknowledgement |
|---|
|
The receiving HIT system being tested shall process the Z23 ACK error notification message correctly; the issue identified in the error notification must be made visible in the system. |
| Description |
|---|
| A patient is seen at a clinic. A new administration is recorded. The IIS is able to process the administration message but finds multiple soft errors (warnings) which it returns in the acknowledgement message. |
| Comments |
|---|
| No Comments |
| Pre Condition |
|---|
| No PreCondition |
| Post Condition |
|---|
| The returned warnings must be visible in the EHR. |
| Test Objectives |
|---|
| This test case assesses the ability of the EHR to accept an acknowledgement message with multiple soft errors (warnings) being returned by the IIS. |
| Evaluation Criteria |
|---|
| Notes for Testers |
|---|
| No Note |
| Description |
|---|
| A 4 year old female, Lacy Wells, is brought to a clinic for a well child visit by her guardian Janelle Trudeau. A clinic staff member collects basic patient demographic information including name, date of birth and sex. A clinic provider, Wilma Thomas (physician ID 654) reviews the patient's vaccination history and determines that the child requires DTaP, polio, MMR and varicella vaccinations. The child is covered by insurance and does not qualify for all Vaccine For Children (VFC) supplied vaccines. The guardian is given the appropriate Vaccine Information Sheet (VIS) to review. After reading it, she agrees that the child should receive all the vaccines. She also agrees that the data should be shared once it is incorporated into the local IIS. Appropriate doses of DTap-IPV (KINRIX) and MMRV (ProQuad) are selected from the clinic's stock of privately funded vaccines. A clinician, Lily Jackson (ID 7824) prepares and administers the doses to the patient and enters the data into the EHR and transmits it to the IIS. |
| Comments |
|---|
| No Comments |
| Pre Condition |
|---|
| No PreCondition |
| Post Condition |
|---|
| No PostCondition |
| Test Objectives |
|---|
| Evaluation Criteria |
|---|
| Message Validation Report. |
| Notes for Testers |
|---|
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | wcApp | Presence-Content Indifferent |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | iisApp | Presence-Content Indifferent |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | IIS | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150625115038.030-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | VXU | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | VXU_V04 | Value-Profile Fixed |
| MSH-10 | Message Control ID | 10746 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | ER | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | AL | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z22 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | wcEHR | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | Indifferent | |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | Indifferent | |
| MSH-22.10 | Organization Identifier | Indifferent | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | IIS | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | Indifferent | |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | Indifferent | |
| MSH-23.10 | Organization Identifier | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID-1 | Set ID - PID | 1 | Value-Profile Fixed |
| PID-3 | Patient Identifier List | ||
| PID-3.1 | ID Number | 22533 | Presence-Content Indifferent |
| PID-3.3 | Check Digit Scheme | Indifferent | |
| PID-3.4 | Assigning Authority | ||
| PID-3.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| PID-3.4.2 | Universal ID | Indifferent | |
| PID-3.4.3 | Universal ID Type | Indifferent | |
| PID-3.5 | Identifier Type Code | MR | Presence-Content Indifferent |
| PID-5 | Patient Name | ||
| PID-5.1 | Family Name | ||
| PID-5.1.1 | Surname | Wells | Presence-Content Indifferent |
| PID-5.1.2 | Own Surname Prefix | ||
| PID-5.1.3 | Own Surname | ||
| PID-5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-5.1.5 | Surname From Partner/Spouse | ||
| PID-5.2 | Given Name | Lacy | Presence-Content Indifferent |
| PID-5.3 | Second and Further Given Names or Initials Thereof | Indifferent | |
| PID-5.7 | Name Type Code | L | Presence-Content Indifferent |
| PID-6 | Mother's Maiden Name | ||
| PID-6.1 | Family Name | ||
| PID-6.1.1 | Surname | Indifferent | |
| PID-6.1.2 | Own Surname Prefix | ||
| PID-6.1.3 | Own Surname | ||
| PID-6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-6.1.5 | Surname From Partner/Spouse | ||
| PID-6.7 | Name Type Code | Indifferent | |
| PID-7 | Date/Time of Birth | ||
| PID-7.1 | Time | 20110430 | Presence-Content Indifferent |
| PID-8 | Administrative Sex | F | Presence-Content Indifferent |
| PID-10 | Race | ||
| PID-10.1 | Identifier | 2106-3 | Presence-Content Indifferent |
| PID-10.2 | Text | White | Presence-Content Indifferent |
| PID-10.3 | Name of Coding System | CDCREC | Value-Profile Fixed |
| PID-10.5 | Alternate Text | Indifferent | |
| PID-10.6 | Name of Alternate Coding System | Indifferent | |
| PID-11 | Patient Address | ||
| PID-11.1 | Street Address | ||
| PID-11.1.1 | Street or Mailing Address | 12 North Oak St | Presence-Content Indifferent |
| PID-11.1.2 | Street Name | ||
| PID-11.1.3 | Dwelling Number | ||
| PID-11.2 | Other Designation | Indifferent | |
| PID-11.3 | City | Bozeman | Presence-Content Indifferent |
| PID-11.4 | State or Province | MT | Presence-Content Indifferent |
| PID-11.5 | Zip or Postal Code | 59715 | Presence-Content Indifferent |
| PID-11.6 | Country | USA | Presence-Content Indifferent |
| PID-11.7 | Address Type | P | Presence-Content Indifferent |
| PID-13 | Phone Number - Home | ||
| PID-13.2 | Telecommunication Use Code | PRN | Presence-Content Indifferent |
| PID-13.3 | Telecommunication Equipment Type | PH | Value-Test Case Fixed |
| PID-13.4 | Email Address | NonPresence | |
| PID-13.6 | Area/City Code | 406 | Presence-Content Indifferent |
| PID-13.7 | Local Number | 5552914 | Presence-Content Indifferent |
| PID-22 | Ethnic Group | ||
| PID-22.1 | Identifier | 2186-5 | Presence-Content Indifferent |
| PID-22.2 | Text | Not Hispanic or Latino | Presence-Content Indifferent |
| PID-22.3 | Name of Coding System | CDCREC | Value-Profile Fixed |
| PID-22.5 | Alternate Text | Indifferent | |
| PID-22.6 | Name of Alternate Coding System | Indifferent | |
| PID-24 | Multiple Birth Indicator | N | Presence-Content Indifferent |
| PID-25 | Birth Order | 1 | Indifferent |
| PID-29 | Patient Death Date and Time | ||
| PID-29.1 | Time | Indifferent | |
| PID-30 | Patient Death Indicator | N | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1-11 | Publicity Code | ||
| PD1-11.1 | Identifier | 01 | Presence-Content Indifferent |
| PD1-11.2 | Text | No reminder/recall | Presence-Content Indifferent |
| PD1-11.3 | Name of Coding System | HL70215 | Value-Profile Fixed |
| PD1-11.5 | Alternate Text | Indifferent | |
| PD1-11.6 | Name of Alternate Coding System | Indifferent | |
| PD1-12 | Protection Indicator | N | Value-Test Case Fixed |
| PD1-13 | Protection Indicator Effective Date | 20150625 | Presence-Content Indifferent |
| PD1-16 | Immunization Registry Status | A | Presence-Content Indifferent |
| PD1-17 | Immunization Registry Status Effective Date | 20110430 | Presence-Content Indifferent |
| PD1-18 | Publicity Code Effective Date | 20150625 | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| NK1-1 | Set ID - NK1 | 1 | Value-Profile Fixed |
| NK1-2 | Name | ||
| NK1-2.1 | Family Name | ||
| NK1-2.1.1 | Surname | Trudeau | Presence-Content Indifferent |
| NK1-2.1.2 | Own Surname Prefix | ||
| NK1-2.1.3 | Own Surname | ||
| NK1-2.1.4 | Surname Prefix From Partner/Spouse | ||
| NK1-2.1.5 | Surname From Partner/Spouse | ||
| NK1-2.2 | Given Name | Janelle | Presence-Content Indifferent |
| NK1-2.3 | Second and Further Given Names or Initials Thereof | Indifferent | |
| NK1-2.7 | Name Type Code | L | Presence-Content Indifferent |
| NK1-3 | Relationship | ||
| NK1-3.1 | Identifier | GRD | Presence-Content Indifferent |
| NK1-3.2 | Text | Guardian | Presence-Content Indifferent |
| NK1-3.3 | Name of Coding System | HL70063 | Value-Profile Fixed |
| NK1-3.5 | Alternate Text | Indifferent | |
| NK1-3.6 | Name of Alternate Coding System | Indifferent | |
| NK1-4 | Address | ||
| NK1-4.1 | Street Address | ||
| NK1-4.1.1 | Street or Mailing Address | 12 North Oak St | Presence-Content Indifferent |
| NK1-4.1.2 | Street Name | ||
| NK1-4.1.3 | Dwelling Number | ||
| NK1-4.2 | Other Designation | Indifferent | |
| NK1-4.3 | City | Bozeman | Presence-Content Indifferent |
| NK1-4.4 | State or Province | MT | Presence-Content Indifferent |
| NK1-4.5 | Zip or Postal Code | 59715 | Presence-Content Indifferent |
| NK1-4.6 | Country | USA | Presence-Content Indifferent |
| NK1-4.7 | Address Type | P | Presence-Content Indifferent |
| NK1-5 | Phone Number | ||
| NK1-5.2 | Telecommunication Use Code | PRN | Presence-Content Indifferent |
| NK1-5.3 | Telecommunication Equipment Type | PH | Value-Test Case Fixed |
| NK1-5.4 | Email Address | NonPresence | |
| NK1-5.6 | Area/City Code | 406 | Presence-Content Indifferent |
| NK1-5.7 | Local Number | 5552914 | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | Value-Profile Fixed |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | 657 | Presence-Content Indifferent |
| ORC-2.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-2.3 | Universal ID | Indifferent | |
| ORC-2.4 | Universal ID Type | Indifferent | |
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 68544 | Presence-Content Indifferent |
| ORC-3.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-3.3 | Universal ID | Indifferent | |
| ORC-3.4 | Universal ID Type | Indifferent | |
| ORC-10 | Entered By | ||
| ORC-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| ORC-10.2 | Family Name | ||
| ORC-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| ORC-10.2.2 | Own Surname Prefix | ||
| ORC-10.2.3 | Own Surname | ||
| ORC-10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-10.2.5 | Surname From Partner/Spouse | ||
| ORC-10.3 | Given Name | Lily | Presence-Content Indifferent |
| ORC-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| ORC-10.9 | Assigning Authority | ||
| ORC-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-10.9.2 | Universal ID | ||
| ORC-10.9.3 | Universal ID Type | ||
| ORC-10.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-10.12 | Check Digit Scheme | Indifferent | |
| ORC-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| ORC-12 | Ordering Provider | ||
| ORC-12.1 | ID Number | 654 | Presence-Content Indifferent |
| ORC-12.2 | Family Name | ||
| ORC-12.2.1 | Surname | Thomas | Presence-Content Indifferent |
| ORC-12.2.2 | Own Surname Prefix | ||
| ORC-12.2.3 | Own Surname | ||
| ORC-12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-12.2.5 | Surname From Partner/Spouse | ||
| ORC-12.3 | Given Name | Wilma | Presence-Content Indifferent |
| ORC-12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | Presence-Content Indifferent |
| ORC-12.9 | Assigning Authority | ||
| ORC-12.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-12.9.2 | Universal ID | ||
| ORC-12.9.3 | Universal ID Type | ||
| ORC-12.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-12.12 | Check Digit Scheme | Indifferent | |
| ORC-12.13 | Identifier Type Code | MD | Presence-Content Indifferent |
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | wcEHR | Presence-Content Indifferent |
| ORC-17.2 | Text | West Clinic | Presence-Content Indifferent |
| ORC-17.3 | Name of Coding System | HL70362 | Value-Profile Fixed |
| ORC-17.5 | Alternate Text | Indifferent | |
| ORC-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | Value-Profile Fixed |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | 7553 | Presence-Content Indifferent |
| ORC-2.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-2.3 | Universal ID | Indifferent | |
| ORC-2.4 | Universal ID Type | Indifferent | |
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 8671 | Presence-Content Indifferent |
| ORC-3.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-3.3 | Universal ID | Indifferent | |
| ORC-3.4 | Universal ID Type | Indifferent | |
| ORC-10 | Entered By | ||
| ORC-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| ORC-10.2 | Family Name | ||
| ORC-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| ORC-10.2.2 | Own Surname Prefix | ||
| ORC-10.2.3 | Own Surname | ||
| ORC-10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-10.2.5 | Surname From Partner/Spouse | ||
| ORC-10.3 | Given Name | Lily | Presence-Content Indifferent |
| ORC-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| ORC-10.9 | Assigning Authority | ||
| ORC-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-10.9.2 | Universal ID | ||
| ORC-10.9.3 | Universal ID Type | ||
| ORC-10.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-10.12 | Check Digit Scheme | Indifferent | |
| ORC-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| ORC-12 | Ordering Provider | ||
| ORC-12.1 | ID Number | 654 | Presence-Content Indifferent |
| ORC-12.2 | Family Name | ||
| ORC-12.2.1 | Surname | Thomas | Presence-Content Indifferent |
| ORC-12.2.2 | Own Surname Prefix | ||
| ORC-12.2.3 | Own Surname | ||
| ORC-12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-12.2.5 | Surname From Partner/Spouse | ||
| ORC-12.3 | Given Name | Wilma | Presence-Content Indifferent |
| ORC-12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | Presence-Content Indifferent |
| ORC-12.9 | Assigning Authority | ||
| ORC-12.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-12.9.2 | Universal ID | ||
| ORC-12.9.3 | Universal ID Type | ||
| ORC-12.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-12.12 | Check Digit Scheme | Indifferent | |
| ORC-12.13 | Identifier Type Code | MD | Presence-Content Indifferent |
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | wcEHR | Presence-Content Indifferent |
| ORC-17.2 | Text | West Clinic | Presence-Content Indifferent |
| ORC-17.3 | Name of Coding System | HL70362 | Value-Profile Fixed |
| ORC-17.5 | Alternate Text | Indifferent | |
| ORC-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | Value-Profile Fixed |
| RXA-2 | Administration Sub-ID Counter | 1 | Value-Profile Fixed |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20150625 | Presence-Content Indifferent |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 00006-4171-01 | Value-Test Case Fixed |
| RXA-5.2 | Text | ProQuad | Presence-Content Indifferent |
| RXA-5.3 | Name of Coding System | NDC | Value-Test Case Fixed |
| RXA-5.5 | Alternate Text | Indifferent | |
| RXA-5.6 | Name of Alternate Coding System | Indifferent | |
| RXA-6 | Administered Amount | 0.5 | Value-Test Case Fixed |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | mL | Value-Test Case Fixed |
| RXA-7.2 | Text | mL | Presence-Content Indifferent |
| RXA-7.3 | Name of Coding System | UCUM | Value-Test Case Fixed |
| RXA-7.5 | Alternate Text | Indifferent | |
| RXA-7.6 | Name of Alternate Coding System | Indifferent | |
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 00 | Value-Test Case Fixed |
| RXA-9.2 | Text | New Record | Presence-Content Indifferent |
| RXA-9.3 | Name of Coding System | NIP001 | Value-Profile Fixed |
| RXA-9.5 | Alternate Text | Indifferent | |
| RXA-9.6 | Name of Alternate Coding System | Indifferent | |
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Lily | Presence-Content Indifferent |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | L | Presence-Content Indifferent |
| RXA-10.12 | Check Digit Scheme | Indifferent | |
| RXA-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-11.4.2 | Universal ID | Indifferent | |
| RXA-11.4.3 | Universal ID Type | Indifferent | |
| RXA-15 | Substance Lot Number | 407453 | Presence-Content Indifferent |
| RXA-16 | Substance Expiration Date | ||
| RXA-16.1 | Time | 20151015 | Presence-Content Indifferent |
| RXA-17 | Substance Manufacturer Name | ||
| RXA-17.1 | Identifier | MSD | Presence-Content Indifferent |
| RXA-17.2 | Text | Merck and Co., Inc. | Presence-Content Indifferent |
| RXA-17.3 | Name of Coding System | MVX | Value-Test Case Fixed |
| RXA-17.5 | Alternate Text | Indifferent | |
| RXA-17.6 | Name of Alternate Coding System | Indifferent | |
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | Indifferent | |
| RXA-18.2 | Text | Indifferent | |
| RXA-18.3 | Name of Coding System | Indifferent | |
| RXA-18.5 | Alternate Text | Indifferent | |
| RXA-18.6 | Name of Alternate Coding System | Indifferent | |
| RXA-20 | Completion Status | CP | Value-Test Case Fixed |
| RXA-21 | Action Code - RXA | A | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | Value-Profile Fixed |
| RXA-2 | Administration Sub-ID Counter | 1 | Value-Profile Fixed |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20150625 | Presence-Content Indifferent |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 58160-0812-01 | Value-Test Case Fixed |
| RXA-5.2 | Text | KINRIX | Presence-Content Indifferent |
| RXA-5.3 | Name of Coding System | NDC | Value-Test Case Fixed |
| RXA-5.5 | Alternate Text | Indifferent | |
| RXA-5.6 | Name of Alternate Coding System | Indifferent | |
| RXA-6 | Administered Amount | 0.5 | Value-Test Case Fixed |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | mL | Value-Test Case Fixed |
| RXA-7.2 | Text | mL | Presence-Content Indifferent |
| RXA-7.3 | Name of Coding System | UCUM | Value-Test Case Fixed |
| RXA-7.5 | Alternate Text | Indifferent | |
| RXA-7.6 | Name of Alternate Coding System | Indifferent | |
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 00 | Value-Test Case Fixed |
| RXA-9.2 | Text | New Record | Presence-Content Indifferent |
| RXA-9.3 | Name of Coding System | NIP001 | Value-Profile Fixed |
| RXA-9.5 | Alternate Text | Indifferent | |
| RXA-9.6 | Name of Alternate Coding System | Indifferent | |
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Lily | Presence-Content Indifferent |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | L | Presence-Content Indifferent |
| RXA-10.12 | Check Digit Scheme | Indifferent | |
| RXA-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-11.4.2 | Universal ID | Indifferent | |
| RXA-11.4.3 | Universal ID Type | Indifferent | |
| RXA-15 | Substance Lot Number | 88402 | Presence-Content Indifferent |
| RXA-16 | Substance Expiration Date | ||
| RXA-16.1 | Time | 20150730 | Presence-Content Indifferent |
| RXA-17 | Substance Manufacturer Name | ||
| RXA-17.1 | Identifier | SKB | Presence-Content Indifferent |
| RXA-17.2 | Text | GlaxoSmithKline | Presence-Content Indifferent |
| RXA-17.3 | Name of Coding System | MVX | Value-Test Case Fixed |
| RXA-17.5 | Alternate Text | Indifferent | |
| RXA-17.6 | Name of Alternate Coding System | Indifferent | |
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | Indifferent | |
| RXA-18.2 | Text | Indifferent | |
| RXA-18.3 | Name of Coding System | Indifferent | |
| RXA-18.5 | Alternate Text | Indifferent | |
| RXA-18.6 | Name of Alternate Coding System | Indifferent | |
| RXA-20 | Completion Status | CP | Value-Test Case Fixed |
| RXA-21 | Action Code - RXA | A | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR-1 | Route | ||
| RXR-1.1 | Identifier | C38299 | Presence-Content Indifferent |
| RXR-1.2 | Text | Subcutaneous | Presence-Content Indifferent |
| RXR-1.3 | Name of Coding System | NCIT | Value-Profile Fixed |
| RXR-1.5 | Alternate Text | Indifferent | |
| RXR-1.6 | Name of Alternate Coding System | Indifferent | |
| RXR-2 | Administration Site | ||
| RXR-2.1 | Identifier | RD | Presence-Content Indifferent |
| RXR-2.2 | Text | Right Deltoid | Presence-Content Indifferent |
| RXR-2.3 | Name of Coding System | HL70163 | Value-Profile Fixed |
| RXR-2.5 | Alternate Text | Indifferent | |
| RXR-2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR-1 | Route | ||
| RXR-1.1 | Identifier | C28161 | Presence-Content Indifferent |
| RXR-1.2 | Text | Intramuscular | Presence-Content Indifferent |
| RXR-1.3 | Name of Coding System | NCIT | Value-Profile Fixed |
| RXR-1.5 | Alternate Text | Indifferent | |
| RXR-1.6 | Name of Alternate Coding System | Indifferent | |
| RXR-2 | Administration Site | ||
| RXR-2.1 | Identifier | LD | Presence-Content Indifferent |
| RXR-2.2 | Text | Left Deltoid | Presence-Content Indifferent |
| RXR-2.3 | Name of Coding System | HL70163 | Value-Profile Fixed |
| RXR-2.5 | Alternate Text | Indifferent | |
| RXR-2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 1 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30963-3 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Source | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 1 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150625 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 2 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 64994-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Program Eligibility | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 2 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150625 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | VXC40 | Value-Test Case Fixed |
| OBX-17.2 | Text | per immunization | Presence-Content Indifferent |
| OBX-17.3 | Name of Coding System | CDCPHINVS | Value-Profile Fixed |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 3 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 69764-9 | Value-Test Case Fixed |
| OBX-3.2 | Text | Document Type | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150625 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 4 | Value-Profile Fixed |
| OBX-2 | Value Type | DT | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 29769-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Date Vis Presented | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | 20150625 | Presence-Content Indifferent |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150625 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 1 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30963-3 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Source | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 1 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150625 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 2 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 64994-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Program Eligibility | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 2 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150625 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | VXC40 | Value-Test Case Fixed |
| OBX-17.2 | Text | per immunization | Presence-Content Indifferent |
| OBX-17.3 | Name of Coding System | CDCPHINVS | Value-Profile Fixed |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 3 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 69764-9 | Value-Test Case Fixed |
| OBX-3.2 | Text | Document Type | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150625 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 4 | Value-Profile Fixed |
| OBX-2 | Value Type | DT | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 29769-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Date Vis Presented | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | 20150625 | Presence-Content Indifferent |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150625 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 5 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 69764-9 | Value-Test Case Fixed |
| OBX-3.2 | Text | Document Type | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 4 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150625 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 6 | Value-Profile Fixed |
| OBX-2 | Value Type | DT | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 29769-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Date Vis Presented | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 4 | Presence-Content Indifferent |
| OBX-5 | Observation Value | 20150625 | Presence-Content Indifferent |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150625 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | wcApp | Presence-Content Indifferent |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | iisApp | Presence-Content Indifferent |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | IIS | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150625115038.030-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | VXU | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | VXU_V04 | Value-Profile Fixed |
| MSH-10 | Message Control ID | 10746 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | ER | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | AL | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z22 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | wcEHR | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | Indifferent | |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | Indifferent | |
| MSH-22.10 | Organization Identifier | Indifferent | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | IIS | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | Indifferent | |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | Indifferent | |
| MSH-23.10 | Organization Identifier | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID-1 | Set ID - PID | 1 | Value-Profile Fixed |
| PID-3 | Patient Identifier List | ||
| PID-3.1 | ID Number | 22533 | Presence-Content Indifferent |
| PID-3.3 | Check Digit Scheme | Indifferent | |
| PID-3.4 | Assigning Authority | ||
| PID-3.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| PID-3.4.2 | Universal ID | Indifferent | |
| PID-3.4.3 | Universal ID Type | Indifferent | |
| PID-3.5 | Identifier Type Code | MR | Presence-Content Indifferent |
| PID-5 | Patient Name | ||
| PID-5.1 | Family Name | ||
| PID-5.1.1 | Surname | Wells | Presence-Content Indifferent |
| PID-5.1.2 | Own Surname Prefix | ||
| PID-5.1.3 | Own Surname | ||
| PID-5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-5.1.5 | Surname From Partner/Spouse | ||
| PID-5.2 | Given Name | Lacy | Presence-Content Indifferent |
| PID-5.3 | Second and Further Given Names or Initials Thereof | Indifferent | |
| PID-5.7 | Name Type Code | L | Presence-Content Indifferent |
| PID-6 | Mother's Maiden Name | ||
| PID-6.1 | Family Name | ||
| PID-6.1.1 | Surname | Indifferent | |
| PID-6.1.2 | Own Surname Prefix | ||
| PID-6.1.3 | Own Surname | ||
| PID-6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-6.1.5 | Surname From Partner/Spouse | ||
| PID-6.7 | Name Type Code | Indifferent | |
| PID-7 | Date/Time of Birth | ||
| PID-7.1 | Time | 20110430 | Presence-Content Indifferent |
| PID-8 | Administrative Sex | F | Presence-Content Indifferent |
| PID-10 | Race | ||
| PID-10.1 | Identifier | 2106-3 | Presence-Content Indifferent |
| PID-10.2 | Text | White | Presence-Content Indifferent |
| PID-10.3 | Name of Coding System | CDCREC | Value-Profile Fixed |
| PID-10.5 | Alternate Text | Indifferent | |
| PID-10.6 | Name of Alternate Coding System | Indifferent | |
| PID-11 | Patient Address | ||
| PID-11.1 | Street Address | ||
| PID-11.1.1 | Street or Mailing Address | 12 North Oak St | Presence-Content Indifferent |
| PID-11.1.2 | Street Name | ||
| PID-11.1.3 | Dwelling Number | ||
| PID-11.2 | Other Designation | Indifferent | |
| PID-11.3 | City | Bozeman | Presence-Content Indifferent |
| PID-11.4 | State or Province | MT | Presence-Content Indifferent |
| PID-11.5 | Zip or Postal Code | 59715 | Presence-Content Indifferent |
| PID-11.6 | Country | USA | Presence-Content Indifferent |
| PID-11.7 | Address Type | P | Presence-Content Indifferent |
| PID-13 | Phone Number - Home | ||
| PID-13.2 | Telecommunication Use Code | PRN | Presence-Content Indifferent |
| PID-13.3 | Telecommunication Equipment Type | PH | Value-Test Case Fixed |
| PID-13.4 | Email Address | NonPresence | |
| PID-13.6 | Area/City Code | 406 | Presence-Content Indifferent |
| PID-13.7 | Local Number | 5552914 | Presence-Content Indifferent |
| PID-22 | Ethnic Group | ||
| PID-22.1 | Identifier | 2186-5 | Presence-Content Indifferent |
| PID-22.2 | Text | Not Hispanic or Latino | Presence-Content Indifferent |
| PID-22.3 | Name of Coding System | CDCREC | Value-Profile Fixed |
| PID-22.5 | Alternate Text | Indifferent | |
| PID-22.6 | Name of Alternate Coding System | Indifferent | |
| PID-24 | Multiple Birth Indicator | N | Presence-Content Indifferent |
| PID-25 | Birth Order | 1 | Indifferent |
| PID-29 | Patient Death Date and Time | ||
| PID-29.1 | Time | Indifferent | |
| PID-30 | Patient Death Indicator | N | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1-11 | Publicity Code | ||
| PD1-11.1 | Identifier | 01 | Presence-Content Indifferent |
| PD1-11.2 | Text | No reminder/recall | Presence-Content Indifferent |
| PD1-11.3 | Name of Coding System | HL70215 | Value-Profile Fixed |
| PD1-11.5 | Alternate Text | Indifferent | |
| PD1-11.6 | Name of Alternate Coding System | Indifferent | |
| PD1-12 | Protection Indicator | N | Value-Test Case Fixed |
| PD1-13 | Protection Indicator Effective Date | 20150625 | Presence-Content Indifferent |
| PD1-16 | Immunization Registry Status | A | Presence-Content Indifferent |
| PD1-17 | Immunization Registry Status Effective Date | 20110430 | Presence-Content Indifferent |
| PD1-18 | Publicity Code Effective Date | 20150625 | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| NK1-1 | Set ID - NK1 | 1 | Value-Profile Fixed |
| NK1-2 | Name | ||
| NK1-2.1 | Family Name | ||
| NK1-2.1.1 | Surname | Trudeau | Presence-Content Indifferent |
| NK1-2.1.2 | Own Surname Prefix | ||
| NK1-2.1.3 | Own Surname | ||
| NK1-2.1.4 | Surname Prefix From Partner/Spouse | ||
| NK1-2.1.5 | Surname From Partner/Spouse | ||
| NK1-2.2 | Given Name | Janelle | Presence-Content Indifferent |
| NK1-2.3 | Second and Further Given Names or Initials Thereof | Indifferent | |
| NK1-2.7 | Name Type Code | L | Presence-Content Indifferent |
| NK1-3 | Relationship | ||
| NK1-3.1 | Identifier | GRD | Presence-Content Indifferent |
| NK1-3.2 | Text | Guardian | Presence-Content Indifferent |
| NK1-3.3 | Name of Coding System | HL70063 | Value-Profile Fixed |
| NK1-3.5 | Alternate Text | Indifferent | |
| NK1-3.6 | Name of Alternate Coding System | Indifferent | |
| NK1-4 | Address | ||
| NK1-4.1 | Street Address | ||
| NK1-4.1.1 | Street or Mailing Address | 12 North Oak St | Presence-Content Indifferent |
| NK1-4.1.2 | Street Name | ||
| NK1-4.1.3 | Dwelling Number | ||
| NK1-4.2 | Other Designation | Indifferent | |
| NK1-4.3 | City | Bozeman | Presence-Content Indifferent |
| NK1-4.4 | State or Province | MT | Presence-Content Indifferent |
| NK1-4.5 | Zip or Postal Code | 59715 | Presence-Content Indifferent |
| NK1-4.6 | Country | USA | Presence-Content Indifferent |
| NK1-4.7 | Address Type | P | Presence-Content Indifferent |
| NK1-5 | Phone Number | ||
| NK1-5.2 | Telecommunication Use Code | PRN | Presence-Content Indifferent |
| NK1-5.3 | Telecommunication Equipment Type | PH | Value-Test Case Fixed |
| NK1-5.4 | Email Address | NonPresence | |
| NK1-5.6 | Area/City Code | 406 | Presence-Content Indifferent |
| NK1-5.7 | Local Number | 5552914 | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | Value-Profile Fixed |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | 657 | Presence-Content Indifferent |
| ORC-2.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-2.3 | Universal ID | Indifferent | |
| ORC-2.4 | Universal ID Type | Indifferent | |
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 68544 | Presence-Content Indifferent |
| ORC-3.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-3.3 | Universal ID | Indifferent | |
| ORC-3.4 | Universal ID Type | Indifferent | |
| ORC-10 | Entered By | ||
| ORC-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| ORC-10.2 | Family Name | ||
| ORC-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| ORC-10.2.2 | Own Surname Prefix | ||
| ORC-10.2.3 | Own Surname | ||
| ORC-10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-10.2.5 | Surname From Partner/Spouse | ||
| ORC-10.3 | Given Name | Lily | Presence-Content Indifferent |
| ORC-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| ORC-10.9 | Assigning Authority | ||
| ORC-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-10.9.2 | Universal ID | ||
| ORC-10.9.3 | Universal ID Type | ||
| ORC-10.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-10.12 | Check Digit Scheme | Indifferent | |
| ORC-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| ORC-12 | Ordering Provider | ||
| ORC-12.1 | ID Number | 654 | Presence-Content Indifferent |
| ORC-12.2 | Family Name | ||
| ORC-12.2.1 | Surname | Thomas | Presence-Content Indifferent |
| ORC-12.2.2 | Own Surname Prefix | ||
| ORC-12.2.3 | Own Surname | ||
| ORC-12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-12.2.5 | Surname From Partner/Spouse | ||
| ORC-12.3 | Given Name | Wilma | Presence-Content Indifferent |
| ORC-12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | Presence-Content Indifferent |
| ORC-12.9 | Assigning Authority | ||
| ORC-12.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-12.9.2 | Universal ID | ||
| ORC-12.9.3 | Universal ID Type | ||
| ORC-12.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-12.12 | Check Digit Scheme | Indifferent | |
| ORC-12.13 | Identifier Type Code | MD | Presence-Content Indifferent |
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | wcEHR | Presence-Content Indifferent |
| ORC-17.2 | Text | West Clinic | Presence-Content Indifferent |
| ORC-17.3 | Name of Coding System | HL70362 | Value-Profile Fixed |
| ORC-17.5 | Alternate Text | Indifferent | |
| ORC-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | Value-Profile Fixed |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | 7553 | Presence-Content Indifferent |
| ORC-2.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-2.3 | Universal ID | Indifferent | |
| ORC-2.4 | Universal ID Type | Indifferent | |
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 8671 | Presence-Content Indifferent |
| ORC-3.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-3.3 | Universal ID | Indifferent | |
| ORC-3.4 | Universal ID Type | Indifferent | |
| ORC-10 | Entered By | ||
| ORC-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| ORC-10.2 | Family Name | ||
| ORC-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| ORC-10.2.2 | Own Surname Prefix | ||
| ORC-10.2.3 | Own Surname | ||
| ORC-10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-10.2.5 | Surname From Partner/Spouse | ||
| ORC-10.3 | Given Name | Lily | Presence-Content Indifferent |
| ORC-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| ORC-10.9 | Assigning Authority | ||
| ORC-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-10.9.2 | Universal ID | ||
| ORC-10.9.3 | Universal ID Type | ||
| ORC-10.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-10.12 | Check Digit Scheme | Indifferent | |
| ORC-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| ORC-12 | Ordering Provider | ||
| ORC-12.1 | ID Number | 654 | Presence-Content Indifferent |
| ORC-12.2 | Family Name | ||
| ORC-12.2.1 | Surname | Thomas | Presence-Content Indifferent |
| ORC-12.2.2 | Own Surname Prefix | ||
| ORC-12.2.3 | Own Surname | ||
| ORC-12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-12.2.5 | Surname From Partner/Spouse | ||
| ORC-12.3 | Given Name | Wilma | Presence-Content Indifferent |
| ORC-12.4 | Second and Further Given Names or Initials Thereof | Elizabeth | Presence-Content Indifferent |
| ORC-12.9 | Assigning Authority | ||
| ORC-12.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-12.9.2 | Universal ID | ||
| ORC-12.9.3 | Universal ID Type | ||
| ORC-12.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-12.12 | Check Digit Scheme | Indifferent | |
| ORC-12.13 | Identifier Type Code | MD | Presence-Content Indifferent |
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | wcEHR | Presence-Content Indifferent |
| ORC-17.2 | Text | West Clinic | Presence-Content Indifferent |
| ORC-17.3 | Name of Coding System | HL70362 | Value-Profile Fixed |
| ORC-17.5 | Alternate Text | Indifferent | |
| ORC-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | Value-Profile Fixed |
| RXA-2 | Administration Sub-ID Counter | 1 | Value-Profile Fixed |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20150625 | Presence-Content Indifferent |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 00006-4171-01 | Value-Test Case Fixed |
| RXA-5.2 | Text | ProQuad | Presence-Content Indifferent |
| RXA-5.3 | Name of Coding System | NDC | Value-Test Case Fixed |
| RXA-5.5 | Alternate Text | Indifferent | |
| RXA-5.6 | Name of Alternate Coding System | Indifferent | |
| RXA-6 | Administered Amount | 0.5 | Value-Test Case Fixed |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | mL | Value-Test Case Fixed |
| RXA-7.2 | Text | mL | Presence-Content Indifferent |
| RXA-7.3 | Name of Coding System | UCUM | Value-Test Case Fixed |
| RXA-7.5 | Alternate Text | Indifferent | |
| RXA-7.6 | Name of Alternate Coding System | Indifferent | |
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 00 | Value-Test Case Fixed |
| RXA-9.2 | Text | New Record | Presence-Content Indifferent |
| RXA-9.3 | Name of Coding System | NIP001 | Value-Profile Fixed |
| RXA-9.5 | Alternate Text | Indifferent | |
| RXA-9.6 | Name of Alternate Coding System | Indifferent | |
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Lily | Presence-Content Indifferent |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | L | Presence-Content Indifferent |
| RXA-10.12 | Check Digit Scheme | Indifferent | |
| RXA-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-11.4.2 | Universal ID | Indifferent | |
| RXA-11.4.3 | Universal ID Type | Indifferent | |
| RXA-15 | Substance Lot Number | 407453 | Presence-Content Indifferent |
| RXA-16 | Substance Expiration Date | ||
| RXA-16.1 | Time | 20151015 | Presence-Content Indifferent |
| RXA-17 | Substance Manufacturer Name | ||
| RXA-17.1 | Identifier | MSD | Presence-Content Indifferent |
| RXA-17.2 | Text | Merck and Co., Inc. | Presence-Content Indifferent |
| RXA-17.3 | Name of Coding System | MVX | Value-Test Case Fixed |
| RXA-17.5 | Alternate Text | Indifferent | |
| RXA-17.6 | Name of Alternate Coding System | Indifferent | |
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | Indifferent | |
| RXA-18.2 | Text | Indifferent | |
| RXA-18.3 | Name of Coding System | Indifferent | |
| RXA-18.5 | Alternate Text | Indifferent | |
| RXA-18.6 | Name of Alternate Coding System | Indifferent | |
| RXA-20 | Completion Status | CP | Value-Test Case Fixed |
| RXA-21 | Action Code - RXA | A | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | Value-Profile Fixed |
| RXA-2 | Administration Sub-ID Counter | 1 | Value-Profile Fixed |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20150625 | Presence-Content Indifferent |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 58160-0812-01 | Value-Test Case Fixed |
| RXA-5.2 | Text | KINRIX | Presence-Content Indifferent |
| RXA-5.3 | Name of Coding System | NDC | Value-Test Case Fixed |
| RXA-5.5 | Alternate Text | Indifferent | |
| RXA-5.6 | Name of Alternate Coding System | Indifferent | |
| RXA-6 | Administered Amount | 0.5 | Value-Test Case Fixed |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | mL | Value-Test Case Fixed |
| RXA-7.2 | Text | mL | Presence-Content Indifferent |
| RXA-7.3 | Name of Coding System | UCUM | Value-Test Case Fixed |
| RXA-7.5 | Alternate Text | Indifferent | |
| RXA-7.6 | Name of Alternate Coding System | Indifferent | |
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 00 | Value-Test Case Fixed |
| RXA-9.2 | Text | New Record | Presence-Content Indifferent |
| RXA-9.3 | Name of Coding System | NIP001 | Value-Profile Fixed |
| RXA-9.5 | Alternate Text | Indifferent | |
| RXA-9.6 | Name of Alternate Coding System | Indifferent | |
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Lily | Presence-Content Indifferent |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | L | Presence-Content Indifferent |
| RXA-10.12 | Check Digit Scheme | Indifferent | |
| RXA-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| RXA-11.4.2 | Universal ID | Indifferent | |
| RXA-11.4.3 | Universal ID Type | Indifferent | |
| RXA-15 | Substance Lot Number | 88402 | Presence-Content Indifferent |
| RXA-16 | Substance Expiration Date | ||
| RXA-16.1 | Time | 20150730 | Presence-Content Indifferent |
| RXA-17 | Substance Manufacturer Name | ||
| RXA-17.1 | Identifier | SKB | Presence-Content Indifferent |
| RXA-17.2 | Text | GlaxoSmithKline | Presence-Content Indifferent |
| RXA-17.3 | Name of Coding System | MVX | Value-Test Case Fixed |
| RXA-17.5 | Alternate Text | Indifferent | |
| RXA-17.6 | Name of Alternate Coding System | Indifferent | |
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | Indifferent | |
| RXA-18.2 | Text | Indifferent | |
| RXA-18.3 | Name of Coding System | Indifferent | |
| RXA-18.5 | Alternate Text | Indifferent | |
| RXA-18.6 | Name of Alternate Coding System | Indifferent | |
| RXA-20 | Completion Status | CP | Value-Test Case Fixed |
| RXA-21 | Action Code - RXA | A | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR-1 | Route | ||
| RXR-1.1 | Identifier | C38299 | Presence-Content Indifferent |
| RXR-1.2 | Text | Subcutaneous | Presence-Content Indifferent |
| RXR-1.3 | Name of Coding System | NCIT | Value-Profile Fixed |
| RXR-1.5 | Alternate Text | Indifferent | |
| RXR-1.6 | Name of Alternate Coding System | Indifferent | |
| RXR-2 | Administration Site | ||
| RXR-2.1 | Identifier | RD | Presence-Content Indifferent |
| RXR-2.2 | Text | Right Deltoid | Presence-Content Indifferent |
| RXR-2.3 | Name of Coding System | HL70163 | Value-Profile Fixed |
| RXR-2.5 | Alternate Text | Indifferent | |
| RXR-2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR-1 | Route | ||
| RXR-1.1 | Identifier | C28161 | Presence-Content Indifferent |
| RXR-1.2 | Text | Intramuscular | Presence-Content Indifferent |
| RXR-1.3 | Name of Coding System | NCIT | Value-Profile Fixed |
| RXR-1.5 | Alternate Text | Indifferent | |
| RXR-1.6 | Name of Alternate Coding System | Indifferent | |
| RXR-2 | Administration Site | ||
| RXR-2.1 | Identifier | LD | Presence-Content Indifferent |
| RXR-2.2 | Text | Left Deltoid | Presence-Content Indifferent |
| RXR-2.3 | Name of Coding System | HL70163 | Value-Profile Fixed |
| RXR-2.5 | Alternate Text | Indifferent | |
| RXR-2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 1 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30963-3 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Source | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 1 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150625 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 2 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 64994-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Program Eligibility | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 2 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150625 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | VXC40 | Value-Test Case Fixed |
| OBX-17.2 | Text | per immunization | Presence-Content Indifferent |
| OBX-17.3 | Name of Coding System | CDCPHINVS | Value-Profile Fixed |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 3 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 69764-9 | Value-Test Case Fixed |
| OBX-3.2 | Text | Document Type | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150625 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 4 | Value-Profile Fixed |
| OBX-2 | Value Type | DT | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 29769-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Date Vis Presented | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | 20150625 | Presence-Content Indifferent |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150625 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 1 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30963-3 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Source | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 1 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150625 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 2 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 64994-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Vaccine Funding Program Eligibility | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 2 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150625 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | VXC40 | Value-Test Case Fixed |
| OBX-17.2 | Text | per immunization | Presence-Content Indifferent |
| OBX-17.3 | Name of Coding System | CDCPHINVS | Value-Profile Fixed |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 3 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 69764-9 | Value-Test Case Fixed |
| OBX-3.2 | Text | Document Type | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150625 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 4 | Value-Profile Fixed |
| OBX-2 | Value Type | DT | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 29769-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Date Vis Presented | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 3 | Presence-Content Indifferent |
| OBX-5 | Observation Value | 20150625 | Presence-Content Indifferent |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150625 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 5 | Value-Profile Fixed |
| OBX-2 | Value Type | CE | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 69764-9 | Value-Test Case Fixed |
| OBX-3.2 | Text | Document Type | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 4 | Presence-Content Indifferent |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150625 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 6 | Value-Profile Fixed |
| OBX-2 | Value Type | DT | Value-Test Case Fixed |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 29769-7 | Value-Test Case Fixed |
| OBX-3.2 | Text | Date Vis Presented | Presence-Content Indifferent |
| OBX-3.3 | Name of Coding System | LN | Value-Profile Fixed |
| OBX-3.5 | Alternate Text | Indifferent | |
| OBX-3.6 | Name of Alternate Coding System | Indifferent | |
| OBX-4 | Observation Sub-ID | 4 | Presence-Content Indifferent |
| OBX-5 | Observation Value | 20150625 | Presence-Content Indifferent |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | Indifferent | |
| OBX-6.2 | Text | Indifferent | |
| OBX-6.3 | Name of Coding System | Indifferent | |
| OBX-6.5 | Alternate Text | Indifferent | |
| OBX-6.6 | Name of Alternate Coding System | Indifferent | |
| OBX-11 | Observation Result Status | F | Value-Profile Fixed |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20150625 | Presence-System Generated |
| OBX-17 | Observation Method | ||
| OBX-17.1 | Identifier | Indifferent | |
| OBX-17.2 | Text | Indifferent | |
| OBX-17.3 | Name of Coding System | Indifferent | |
| OBX-17.5 | Alternate Text | Indifferent | |
| OBX-17.6 | Name of Alternate Coding System | Indifferent |
| Element | Data |
|---|---|
| Patient Name | Lacy Wells |
| Mother's Maiden Name | |
| ID Number | 22533 |
| Date/Time of Birth | 04/30/2011 |
| Administrative Sex | Female |
| Patient Address | 12 North Oak St Bozeman MT 59715 USA |
| Local Number | (406)555-2914 |
| Race | White |
| Ethnic Group | Not Hispanic or Latino |
| Multiple Birth Indicator | N |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 04/30/2011 |
| Publicity Code | No reminder/recall |
| Publicity Code Effective Date | 06/25/2015 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 06/25/2015 |
| Element | Data |
|---|---|
| Name | Janelle Trudeau |
| Relationship | Guardian |
| Address | 12 North Oak St Bozeman MT 59715 USA |
| Phone Number | (406)555-2914 |
| Element | Data |
|---|---|
| Administered Code | ProQuad |
| Date/Time Start of Administration | 06/25/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 407453 |
| Substance Expiration Date | 10/15/2015 |
| Substance Manufacturer Name | Merck and Co., Inc. |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Subcutaneous |
| Administration Site | Right Deltoid |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Private |
| Vaccine Funding Program Eligibility | Not VFC Eligible |
| Document Type | Measles/Mumps/Rubella/Varicella VIS |
| Date Vis Presented | 06/25/2015 |
| Element | Data |
|---|---|
| Administered Code | KINRIX |
| Date/Time Start of Administration | 06/25/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 88402 |
| Substance Expiration Date | 07/30/2015 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Deltoid |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Private |
| Vaccine Funding Program Eligibility | Not VFC Eligible |
| Document Type | Polio VIS |
| Date Vis Presented | 06/25/2015 |
| Document Type | Diphtheria/Tetanus/Pertussis (DTaP) VIS |
| Date Vis Presented | 06/25/2015 |
| Element | Data |
|---|---|
| Patient Name | Lacy Wells |
| Mother's Maiden Name | |
| ID Number | 22533 |
| Date/Time of Birth | 04/30/2011 |
| Administrative Sex | Female |
| Patient Address | 12 North Oak St Bozeman MT 59715 USA |
| Local Number | (406)555-2914 |
| Race | White |
| Ethnic Group | Not Hispanic or Latino |
| Multiple Birth Indicator | N |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 04/30/2011 |
| Publicity Code | No reminder/recall |
| Publicity Code Effective Date | 06/25/2015 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 06/25/2015 |
| Element | Data |
|---|---|
| Name | Janelle Trudeau |
| Relationship | Guardian |
| Address | 12 North Oak St Bozeman MT 59715 USA |
| Phone Number | (406)555-2914 |
| Element | Data |
|---|---|
| Administered Code | ProQuad |
| Date/Time Start of Administration | 06/25/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 407453 |
| Substance Expiration Date | 10/15/2015 |
| Substance Manufacturer Name | Merck and Co., Inc. |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Subcutaneous |
| Administration Site | Right Deltoid |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Private |
| Vaccine Funding Program Eligibility | Not VFC Eligible |
| Document Type | Measles/Mumps/Rubella/Varicella VIS |
| Date Vis Presented | 06/25/2015 |
| Element | Data |
|---|---|
| Administered Code | KINRIX |
| Date/Time Start of Administration | 06/25/2015 |
| Administered Amount | 0.5 |
| Administered Units | mL |
| Administration Notes | New Record |
| Administering Provider | Lily Jackson |
| Substance Lot Number | 88402 |
| Substance Expiration Date | 07/30/2015 |
| Substance Manufacturer Name | GlaxoSmithKline |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | Intramuscular |
| Administration Site | Left Deltoid |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By | Wilma Thomas |
| Element | Data |
|---|---|
| Vaccine Funding Source | Private |
| Vaccine Funding Program Eligibility | Not VFC Eligible |
| Document Type | Polio VIS |
| Date Vis Presented | 06/25/2015 |
| Document Type | Diphtheria/Tetanus/Pertussis (DTaP) VIS |
| Date Vis Presented | 06/25/2015 |
| Description |
|---|
| A mapping error in the IIS software results in the IIS being unable to recognize either administration site sent in RXR-2 even though it is valid. The acknowledgement message returned contains warnings for the invalid values. |
| Comments |
|---|
| No Comments |
| Pre Condition |
|---|
| A VXU message is generated by the EHR. |
| Post Condition |
|---|
| No PostCondition |
| Test Objectives |
|---|
| Handling of an ACK message returned by the IIS with multiple warnings. |
| Evaluation Criteria |
|---|
| The warnings returned in the acknowledgement message are visible in the system responsible for the content of the administration message. |
| Notes for Testers |
|---|
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | iisApp | Presence-Content Indifferent |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | IIS | Presence-Content Indifferent |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | wcApp | Presence-Content Indifferent |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150625115038.044-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | ACK | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | ACK | Value-Profile Fixed |
| MSH-10 | Message Control ID | 29540 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z23 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | IIS | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | Indifferent | |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | Indifferent | |
| MSH-22.10 | Organization Identifier | Indifferent | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | wcEHR | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | Indifferent | |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | Indifferent | |
| MSH-23.10 | Organization Identifier | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA-1 | Acknowledgment Code | AE | Value-Test Case Fixed |
| MSA-2 | Message Control ID | 10746 | Presence-System Generated |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ERR-2 | Error Location | ||
| ERR-2.1 | Segment ID | RXR | Value-Test Case Fixed |
| ERR-2.2 | Segment Sequence | 1 | Value-Test Case Fixed |
| ERR-2.3 | Field Position | 2 | Value-Test Case Fixed |
| ERR-2.4 | Field Repetition | 1 | Value-Test Case Fixed |
| ERR-2.5 | Component Number | 1 | Value-Test Case Fixed |
| ERR-2.6 | Sub-Component Number | Indifferent | |
| ERR-3 | HL7 Error Code | ||
| ERR-3.1 | Identifier | 999 | Value-Test Case Fixed |
| ERR-3.2 | Text | Application error | Presence-Content Indifferent |
| ERR-3.3 | Name of Coding System | HL70357 | Value-Profile Fixed |
| ERR-3.5 | Alternate Text | Indifferent | |
| ERR-3.6 | Name of Alternate Coding System | Indifferent | |
| ERR-4 | Severity | W | Value-Test Case Fixed |
| ERR-5 | Application Error Code | ||
| ERR-5.1 | Identifier | 5 | Value-Test Case Fixed |
| ERR-5.2 | Text | Table value not found | Presence-Content Indifferent |
| ERR-5.3 | Name of Coding System | HL70533 | Value-Profile Fixed |
| ERR-5.5 | Alternate Text | Indifferent | |
| ERR-5.6 | Name of Alternate Coding System | Indifferent | |
| ERR-8 | User Message | Administration Site not recognized - site data will not be saved | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ERR-2 | Error Location | ||
| ERR-2.1 | Segment ID | RXR | Value-Test Case Fixed |
| ERR-2.2 | Segment Sequence | 2 | Value-Test Case Fixed |
| ERR-2.3 | Field Position | 2 | Value-Test Case Fixed |
| ERR-2.4 | Field Repetition | 1 | Value-Test Case Fixed |
| ERR-2.5 | Component Number | 1 | Value-Test Case Fixed |
| ERR-2.6 | Sub-Component Number | Indifferent | |
| ERR-3 | HL7 Error Code | ||
| ERR-3.1 | Identifier | 999 | Value-Test Case Fixed |
| ERR-3.2 | Text | Application error | Presence-Content Indifferent |
| ERR-3.3 | Name of Coding System | HL70357 | Value-Profile Fixed |
| ERR-3.5 | Alternate Text | Indifferent | |
| ERR-3.6 | Name of Alternate Coding System | Indifferent | |
| ERR-4 | Severity | W | Value-Test Case Fixed |
| ERR-5 | Application Error Code | ||
| ERR-5.1 | Identifier | 5 | Value-Test Case Fixed |
| ERR-5.2 | Text | Table value not found | Presence-Content Indifferent |
| ERR-5.3 | Name of Coding System | HL70533 | Value-Profile Fixed |
| ERR-5.5 | Alternate Text | Indifferent | |
| ERR-5.6 | Name of Alternate Coding System | Indifferent | |
| ERR-8 | User Message | Administration Site not recognized - site data will not be saved | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | iisApp | Presence-Content Indifferent |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | IIS | Presence-Content Indifferent |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | wcApp | Presence-Content Indifferent |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150625115038.044-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | ACK | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | ACK | Value-Profile Fixed |
| MSH-10 | Message Control ID | 29540 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z23 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | IIS | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | Indifferent | |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | Indifferent | |
| MSH-22.10 | Organization Identifier | Indifferent | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | wcEHR | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | Indifferent | |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | Indifferent | |
| MSH-23.10 | Organization Identifier | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA-1 | Acknowledgment Code | AE | Value-Test Case Fixed |
| MSA-2 | Message Control ID | 10746 | Presence-System Generated |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ERR-2 | Error Location | ||
| ERR-2.1 | Segment ID | RXR | Value-Test Case Fixed |
| ERR-2.2 | Segment Sequence | 1 | Value-Test Case Fixed |
| ERR-2.3 | Field Position | 2 | Value-Test Case Fixed |
| ERR-2.4 | Field Repetition | 1 | Value-Test Case Fixed |
| ERR-2.5 | Component Number | 1 | Value-Test Case Fixed |
| ERR-2.6 | Sub-Component Number | Indifferent | |
| ERR-3 | HL7 Error Code | ||
| ERR-3.1 | Identifier | 999 | Value-Test Case Fixed |
| ERR-3.2 | Text | Application error | Presence-Content Indifferent |
| ERR-3.3 | Name of Coding System | HL70357 | Value-Profile Fixed |
| ERR-3.5 | Alternate Text | Indifferent | |
| ERR-3.6 | Name of Alternate Coding System | Indifferent | |
| ERR-4 | Severity | W | Value-Test Case Fixed |
| ERR-5 | Application Error Code | ||
| ERR-5.1 | Identifier | 5 | Value-Test Case Fixed |
| ERR-5.2 | Text | Table value not found | Presence-Content Indifferent |
| ERR-5.3 | Name of Coding System | HL70533 | Value-Profile Fixed |
| ERR-5.5 | Alternate Text | Indifferent | |
| ERR-5.6 | Name of Alternate Coding System | Indifferent | |
| ERR-8 | User Message | Administration Site not recognized - site data will not be saved | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ERR-2 | Error Location | ||
| ERR-2.1 | Segment ID | RXR | Value-Test Case Fixed |
| ERR-2.2 | Segment Sequence | 2 | Value-Test Case Fixed |
| ERR-2.3 | Field Position | 2 | Value-Test Case Fixed |
| ERR-2.4 | Field Repetition | 1 | Value-Test Case Fixed |
| ERR-2.5 | Component Number | 1 | Value-Test Case Fixed |
| ERR-2.6 | Sub-Component Number | Indifferent | |
| ERR-3 | HL7 Error Code | ||
| ERR-3.1 | Identifier | 999 | Value-Test Case Fixed |
| ERR-3.2 | Text | Application error | Presence-Content Indifferent |
| ERR-3.3 | Name of Coding System | HL70357 | Value-Profile Fixed |
| ERR-3.5 | Alternate Text | Indifferent | |
| ERR-3.6 | Name of Alternate Coding System | Indifferent | |
| ERR-4 | Severity | W | Value-Test Case Fixed |
| ERR-5 | Application Error Code | ||
| ERR-5.1 | Identifier | 5 | Value-Test Case Fixed |
| ERR-5.2 | Text | Table value not found | Presence-Content Indifferent |
| ERR-5.3 | Name of Coding System | HL70533 | Value-Profile Fixed |
| ERR-5.5 | Alternate Text | Indifferent | |
| ERR-5.6 | Name of Alternate Coding System | Indifferent | |
| ERR-8 | User Message | Administration Site not recognized - site data will not be saved | Presence-Content Indifferent |
| Return an Acknowledgement | |||||
|---|---|---|---|---|---|
| Test Case ID | IZ-AD-9_Admin_IIS-2Warnings | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement (Pass/Fail) |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which an Error is returned in the message.
The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.
| Return an Acknowledgement |
|---|
|
The receiving HIT system being tested shall process the Z23 ACK error notification message correctly; the issue identified in the error notification must be made visible in the system. |
| Description |
|---|
| A patient is seen at a clinic. A historical vaccination is recorded but the IIS is unable to process the administration message, rejects it and returns a fatal error in the acknowledgement message. |
| Comments |
|---|
| No Comments |
| Pre Condition |
|---|
| No PreCondition |
| Post Condition |
|---|
| The returned error must be visible in the EHR. |
| Test Objectives |
|---|
| This test case assesses the ability of the EHR to accept an acknowledgement message with a fatal system error being returned by the IIS. |
| Evaluation Criteria |
|---|
| Notes for Testers |
|---|
| No Note |
| Description |
|---|
| A 68 year old male, Manuel Diego Vasquez, comes to a clinic for a physical. A clinic staff member collects basic patient demographic information including name, date of birth and sex. The patient reports that he received a pneumococcal vaccination at a local pharmacy on October 21, 2014. The clinic staff determine that no further vaccinations are required. A clinician, Lily Jackson (ID 7824) enters the historical data into the EHR and transmits it to the IIS. |
| Comments |
|---|
| No Comments |
| Pre Condition |
|---|
| No PreCondition |
| Post Condition |
|---|
| No PostCondition |
| Test Objectives |
|---|
| Evaluation Criteria |
|---|
| Message Validation Report. |
| Notes for Testers |
|---|
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | wcApp | Presence-Content Indifferent |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | iisApp | Presence-Content Indifferent |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | IIS | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150625072816.601-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | VXU | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | VXU_V04 | Value-Profile Fixed |
| MSH-10 | Message Control ID | 41821 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | ER | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | AL | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z22 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | wcEHR | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | Indifferent | |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | Indifferent | |
| MSH-22.10 | Organization Identifier | Indifferent | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | IIS | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | Indifferent | |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | Indifferent | |
| MSH-23.10 | Organization Identifier | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID-1 | Set ID - PID | 1 | Value-Profile Fixed |
| PID-3 | Patient Identifier List | ||
| PID-3.1 | ID Number | 21142 | Presence-Content Indifferent |
| PID-3.3 | Check Digit Scheme | Indifferent | |
| PID-3.4 | Assigning Authority | ||
| PID-3.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| PID-3.4.2 | Universal ID | Indifferent | |
| PID-3.4.3 | Universal ID Type | Indifferent | |
| PID-3.5 | Identifier Type Code | MR | Presence-Content Indifferent |
| PID-5 | Patient Name | ||
| PID-5.1 | Family Name | ||
| PID-5.1.1 | Surname | Vasquez | Presence-Content Indifferent |
| PID-5.1.2 | Own Surname Prefix | ||
| PID-5.1.3 | Own Surname | ||
| PID-5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-5.1.5 | Surname From Partner/Spouse | ||
| PID-5.2 | Given Name | Manuel | Presence-Content Indifferent |
| PID-5.3 | Second and Further Given Names or Initials Thereof | Diego | Presence-Content Indifferent |
| PID-5.7 | Name Type Code | L | Presence-Content Indifferent |
| PID-6 | Mother's Maiden Name | ||
| PID-6.1 | Family Name | ||
| PID-6.1.1 | Surname | Indifferent | |
| PID-6.1.2 | Own Surname Prefix | ||
| PID-6.1.3 | Own Surname | ||
| PID-6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-6.1.5 | Surname From Partner/Spouse | ||
| PID-6.7 | Name Type Code | Indifferent | |
| PID-7 | Date/Time of Birth | ||
| PID-7.1 | Time | 19470215 | Presence-Content Indifferent |
| PID-8 | Administrative Sex | M | Presence-Content Indifferent |
| PID-10 | Race | ||
| PID-10.1 | Identifier | 2106-3 | Presence-Content Indifferent |
| PID-10.2 | Text | White | Presence-Content Indifferent |
| PID-10.3 | Name of Coding System | CDCREC | Value-Profile Fixed |
| PID-10.5 | Alternate Text | Indifferent | |
| PID-10.6 | Name of Alternate Coding System | Indifferent | |
| PID-11 | Patient Address | ||
| PID-11.1 | Street Address | ||
| PID-11.1.1 | Street or Mailing Address | 227 Park Ave | Presence-Content Indifferent |
| PID-11.1.2 | Street Name | ||
| PID-11.1.3 | Dwelling Number | ||
| PID-11.2 | Other Designation | Indifferent | |
| PID-11.3 | City | Bozeman | Presence-Content Indifferent |
| PID-11.4 | State or Province | MT | Presence-Content Indifferent |
| PID-11.5 | Zip or Postal Code | 59715 | Presence-Content Indifferent |
| PID-11.6 | Country | USA | Presence-Content Indifferent |
| PID-11.7 | Address Type | P | Presence-Content Indifferent |
| PID-13[1] | Phone Number - Home | ||
| PID-13[1].2 | Telecommunication Use Code | PRN | Presence-Content Indifferent |
| PID-13[1].3 | Telecommunication Equipment Type | PH | Value-Test Case Fixed |
| PID-13[1].4 | Email Address | NonPresence | |
| PID-13[1].6 | Area/City Code | 406 | Presence-Content Indifferent |
| PID-13[1].7 | Local Number | 5555815 | Presence-Content Indifferent |
| PID-13[2] | Phone Number - Home | ||
| PID-13[2].2 | Telecommunication Use Code | NET | Value-Test Case Fixed |
| PID-13[2].3 | Telecommunication Equipment Type | Internet | Value-Test Case Fixed |
| PID-13[2].4 | Email Address | Manuel.Vasquez@isp.com | Presence-Content Indifferent |
| PID-13[2].6 | Area/City Code | NonPresence | |
| PID-13[2].7 | Local Number | NonPresence | |
| PID-22 | Ethnic Group | ||
| PID-22.1 | Identifier | 2135-2 | Presence-Content Indifferent |
| PID-22.2 | Text | Hispanic or Latino | Presence-Content Indifferent |
| PID-22.3 | Name of Coding System | CDCREC | Value-Profile Fixed |
| PID-22.5 | Alternate Text | Indifferent | |
| PID-22.6 | Name of Alternate Coding System | Indifferent | |
| PID-24 | Multiple Birth Indicator | N | Presence-Content Indifferent |
| PID-25 | Birth Order | 1 | Indifferent |
| PID-29 | Patient Death Date and Time | ||
| PID-29.1 | Time | Indifferent | |
| PID-30 | Patient Death Indicator | N | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1-11 | Publicity Code | ||
| PD1-11.1 | Identifier | 01 | Presence-Content Indifferent |
| PD1-11.2 | Text | No reminder/recall | Presence-Content Indifferent |
| PD1-11.3 | Name of Coding System | HL70215 | Value-Profile Fixed |
| PD1-11.5 | Alternate Text | Indifferent | |
| PD1-11.6 | Name of Alternate Coding System | Indifferent | |
| PD1-12 | Protection Indicator | N | Value-Test Case Fixed |
| PD1-13 | Protection Indicator Effective Date | 20150625 | Presence-Content Indifferent |
| PD1-16 | Immunization Registry Status | A | Presence-Content Indifferent |
| PD1-17 | Immunization Registry Status Effective Date | 20150625 | Presence-Content Indifferent |
| PD1-18 | Publicity Code Effective Date | 20150625 | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | Value-Profile Fixed |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | 4486 | Presence-Content Indifferent |
| ORC-2.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-2.3 | Universal ID | Indifferent | |
| ORC-2.4 | Universal ID Type | Indifferent | |
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 31165 | Presence-Content Indifferent |
| ORC-3.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-3.3 | Universal ID | Indifferent | |
| ORC-3.4 | Universal ID Type | Indifferent | |
| ORC-10 | Entered By | ||
| ORC-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| ORC-10.2 | Family Name | ||
| ORC-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| ORC-10.2.2 | Own Surname Prefix | ||
| ORC-10.2.3 | Own Surname | ||
| ORC-10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-10.2.5 | Surname From Partner/Spouse | ||
| ORC-10.3 | Given Name | Lily | Presence-Content Indifferent |
| ORC-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| ORC-10.9 | Assigning Authority | ||
| ORC-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-10.9.2 | Universal ID | ||
| ORC-10.9.3 | Universal ID Type | ||
| ORC-10.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-10.12 | Check Digit Scheme | Indifferent | |
| ORC-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| ORC-12 | Ordering Provider | ||
| ORC-12.1 | ID Number | Indifferent | |
| ORC-12.2 | Family Name | ||
| ORC-12.2.1 | Surname | Indifferent | |
| ORC-12.2.2 | Own Surname Prefix | ||
| ORC-12.2.3 | Own Surname | ||
| ORC-12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-12.2.5 | Surname From Partner/Spouse | ||
| ORC-12.3 | Given Name | Indifferent | |
| ORC-12.4 | Second and Further Given Names or Initials Thereof | Indifferent | |
| ORC-12.9 | Assigning Authority | ||
| ORC-12.9.1 | Namespace ID | Indifferent | |
| ORC-12.9.2 | Universal ID | ||
| ORC-12.9.3 | Universal ID Type | ||
| ORC-12.10 | Name Type Code | Indifferent | |
| ORC-12.12 | Check Digit Scheme | Indifferent | |
| ORC-12.13 | Identifier Type Code | Indifferent | |
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | wcEHR | Presence-Content Indifferent |
| ORC-17.2 | Text | West Clinic | Presence-Content Indifferent |
| ORC-17.3 | Name of Coding System | HL70362 | Value-Profile Fixed |
| ORC-17.5 | Alternate Text | Indifferent | |
| ORC-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | Value-Profile Fixed |
| RXA-2 | Administration Sub-ID Counter | 1 | Value-Profile Fixed |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20141021 | Presence-Content Indifferent |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 152 | Value-Test Case Fixed |
| RXA-5.2 | Text | Pneumococcal Conjugate, unspecified formulation | Presence-Content Indifferent |
| RXA-5.3 | Name of Coding System | CVX | Value-Test Case Fixed |
| RXA-5.5 | Alternate Text | Indifferent | |
| RXA-5.6 | Name of Alternate Coding System | Indifferent | |
| RXA-6 | Administered Amount | 999 | Value-Test Case Fixed |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | NonPresence | |
| RXA-7.2 | Text | NonPresence | |
| RXA-7.3 | Name of Coding System | NonPresence | |
| RXA-7.5 | Alternate Text | NonPresence | |
| RXA-7.6 | Name of Alternate Coding System | NonPresence | |
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 01 | Value-Test Case Fixed |
| RXA-9.2 | Text | Historical Administration | Presence-Content Indifferent |
| RXA-9.3 | Name of Coding System | NIP001 | Value-Profile Fixed |
| RXA-9.5 | Alternate Text | Indifferent | |
| RXA-9.6 | Name of Alternate Coding System | Indifferent | |
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | Indifferent | |
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Indifferent | |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Indifferent | |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | Indifferent | |
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | Indifferent | |
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | Indifferent | |
| RXA-10.12 | Check Digit Scheme | Indifferent | |
| RXA-10.13 | Identifier Type Code | Indifferent | |
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | Indifferent | |
| RXA-11.4.2 | Universal ID | Indifferent | |
| RXA-11.4.3 | Universal ID Type | Indifferent | |
| RXA-15 | Substance Lot Number | Indifferent | |
| RXA-16 | Substance Expiration Date | ||
| RXA-16.1 | Time | Indifferent | |
| RXA-17 | Substance Manufacturer Name | ||
| RXA-17.1 | Identifier | Indifferent | |
| RXA-17.2 | Text | Indifferent | |
| RXA-17.3 | Name of Coding System | Indifferent | |
| RXA-17.5 | Alternate Text | Indifferent | |
| RXA-17.6 | Name of Alternate Coding System | Indifferent | |
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | Indifferent | |
| RXA-18.2 | Text | Indifferent | |
| RXA-18.3 | Name of Coding System | Indifferent | |
| RXA-18.5 | Alternate Text | Indifferent | |
| RXA-18.6 | Name of Alternate Coding System | Indifferent | |
| RXA-20 | Completion Status | CP | Value-Test Case Fixed |
| RXA-21 | Action Code - RXA | A | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | wcApp | Presence-Content Indifferent |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | iisApp | Presence-Content Indifferent |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | IIS | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150625072816.601-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | VXU | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | VXU_V04 | Value-Profile Fixed |
| MSH-10 | Message Control ID | 41821 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | ER | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | AL | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z22 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | wcEHR | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | Indifferent | |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | Indifferent | |
| MSH-22.10 | Organization Identifier | Indifferent | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | IIS | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | Indifferent | |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | Indifferent | |
| MSH-23.10 | Organization Identifier | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID-1 | Set ID - PID | 1 | Value-Profile Fixed |
| PID-3 | Patient Identifier List | ||
| PID-3.1 | ID Number | 21142 | Presence-Content Indifferent |
| PID-3.3 | Check Digit Scheme | Indifferent | |
| PID-3.4 | Assigning Authority | ||
| PID-3.4.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| PID-3.4.2 | Universal ID | Indifferent | |
| PID-3.4.3 | Universal ID Type | Indifferent | |
| PID-3.5 | Identifier Type Code | MR | Presence-Content Indifferent |
| PID-5 | Patient Name | ||
| PID-5.1 | Family Name | ||
| PID-5.1.1 | Surname | Vasquez | Presence-Content Indifferent |
| PID-5.1.2 | Own Surname Prefix | ||
| PID-5.1.3 | Own Surname | ||
| PID-5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-5.1.5 | Surname From Partner/Spouse | ||
| PID-5.2 | Given Name | Manuel | Presence-Content Indifferent |
| PID-5.3 | Second and Further Given Names or Initials Thereof | Diego | Presence-Content Indifferent |
| PID-5.7 | Name Type Code | L | Presence-Content Indifferent |
| PID-6 | Mother's Maiden Name | ||
| PID-6.1 | Family Name | ||
| PID-6.1.1 | Surname | Indifferent | |
| PID-6.1.2 | Own Surname Prefix | ||
| PID-6.1.3 | Own Surname | ||
| PID-6.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-6.1.5 | Surname From Partner/Spouse | ||
| PID-6.7 | Name Type Code | Indifferent | |
| PID-7 | Date/Time of Birth | ||
| PID-7.1 | Time | 19470215 | Presence-Content Indifferent |
| PID-8 | Administrative Sex | M | Presence-Content Indifferent |
| PID-10 | Race | ||
| PID-10.1 | Identifier | 2106-3 | Presence-Content Indifferent |
| PID-10.2 | Text | White | Presence-Content Indifferent |
| PID-10.3 | Name of Coding System | CDCREC | Value-Profile Fixed |
| PID-10.5 | Alternate Text | Indifferent | |
| PID-10.6 | Name of Alternate Coding System | Indifferent | |
| PID-11 | Patient Address | ||
| PID-11.1 | Street Address | ||
| PID-11.1.1 | Street or Mailing Address | 227 Park Ave | Presence-Content Indifferent |
| PID-11.1.2 | Street Name | ||
| PID-11.1.3 | Dwelling Number | ||
| PID-11.2 | Other Designation | Indifferent | |
| PID-11.3 | City | Bozeman | Presence-Content Indifferent |
| PID-11.4 | State or Province | MT | Presence-Content Indifferent |
| PID-11.5 | Zip or Postal Code | 59715 | Presence-Content Indifferent |
| PID-11.6 | Country | USA | Presence-Content Indifferent |
| PID-11.7 | Address Type | P | Presence-Content Indifferent |
| PID-13[1] | Phone Number - Home | ||
| PID-13[1].2 | Telecommunication Use Code | PRN | Presence-Content Indifferent |
| PID-13[1].3 | Telecommunication Equipment Type | PH | Value-Test Case Fixed |
| PID-13[1].4 | Email Address | NonPresence | |
| PID-13[1].6 | Area/City Code | 406 | Presence-Content Indifferent |
| PID-13[1].7 | Local Number | 5555815 | Presence-Content Indifferent |
| PID-13[2] | Phone Number - Home | ||
| PID-13[2].2 | Telecommunication Use Code | NET | Value-Test Case Fixed |
| PID-13[2].3 | Telecommunication Equipment Type | Internet | Value-Test Case Fixed |
| PID-13[2].4 | Email Address | Manuel.Vasquez@isp.com | Presence-Content Indifferent |
| PID-13[2].6 | Area/City Code | NonPresence | |
| PID-13[2].7 | Local Number | NonPresence | |
| PID-22 | Ethnic Group | ||
| PID-22.1 | Identifier | 2135-2 | Presence-Content Indifferent |
| PID-22.2 | Text | Hispanic or Latino | Presence-Content Indifferent |
| PID-22.3 | Name of Coding System | CDCREC | Value-Profile Fixed |
| PID-22.5 | Alternate Text | Indifferent | |
| PID-22.6 | Name of Alternate Coding System | Indifferent | |
| PID-24 | Multiple Birth Indicator | N | Presence-Content Indifferent |
| PID-25 | Birth Order | 1 | Indifferent |
| PID-29 | Patient Death Date and Time | ||
| PID-29.1 | Time | Indifferent | |
| PID-30 | Patient Death Indicator | N | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PD1-11 | Publicity Code | ||
| PD1-11.1 | Identifier | 01 | Presence-Content Indifferent |
| PD1-11.2 | Text | No reminder/recall | Presence-Content Indifferent |
| PD1-11.3 | Name of Coding System | HL70215 | Value-Profile Fixed |
| PD1-11.5 | Alternate Text | Indifferent | |
| PD1-11.6 | Name of Alternate Coding System | Indifferent | |
| PD1-12 | Protection Indicator | N | Value-Test Case Fixed |
| PD1-13 | Protection Indicator Effective Date | 20150625 | Presence-Content Indifferent |
| PD1-16 | Immunization Registry Status | A | Presence-Content Indifferent |
| PD1-17 | Immunization Registry Status Effective Date | 20150625 | Presence-Content Indifferent |
| PD1-18 | Publicity Code Effective Date | 20150625 | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | Value-Profile Fixed |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | 4486 | Presence-Content Indifferent |
| ORC-2.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-2.3 | Universal ID | Indifferent | |
| ORC-2.4 | Universal ID Type | Indifferent | |
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 31165 | Presence-Content Indifferent |
| ORC-3.2 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-3.3 | Universal ID | Indifferent | |
| ORC-3.4 | Universal ID Type | Indifferent | |
| ORC-10 | Entered By | ||
| ORC-10.1 | ID Number | 7824 | Presence-Content Indifferent |
| ORC-10.2 | Family Name | ||
| ORC-10.2.1 | Surname | Jackson | Presence-Content Indifferent |
| ORC-10.2.2 | Own Surname Prefix | ||
| ORC-10.2.3 | Own Surname | ||
| ORC-10.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-10.2.5 | Surname From Partner/Spouse | ||
| ORC-10.3 | Given Name | Lily | Presence-Content Indifferent |
| ORC-10.4 | Second and Further Given Names or Initials Thereof | Suzanne | Presence-Content Indifferent |
| ORC-10.9 | Assigning Authority | ||
| ORC-10.9.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| ORC-10.9.2 | Universal ID | ||
| ORC-10.9.3 | Universal ID Type | ||
| ORC-10.10 | Name Type Code | L | Presence-Content Indifferent |
| ORC-10.12 | Check Digit Scheme | Indifferent | |
| ORC-10.13 | Identifier Type Code | PRN | Presence-Content Indifferent |
| ORC-12 | Ordering Provider | ||
| ORC-12.1 | ID Number | Indifferent | |
| ORC-12.2 | Family Name | ||
| ORC-12.2.1 | Surname | Indifferent | |
| ORC-12.2.2 | Own Surname Prefix | ||
| ORC-12.2.3 | Own Surname | ||
| ORC-12.2.4 | Surname Prefix From Partner/Spouse | ||
| ORC-12.2.5 | Surname From Partner/Spouse | ||
| ORC-12.3 | Given Name | Indifferent | |
| ORC-12.4 | Second and Further Given Names or Initials Thereof | Indifferent | |
| ORC-12.9 | Assigning Authority | ||
| ORC-12.9.1 | Namespace ID | Indifferent | |
| ORC-12.9.2 | Universal ID | ||
| ORC-12.9.3 | Universal ID Type | ||
| ORC-12.10 | Name Type Code | Indifferent | |
| ORC-12.12 | Check Digit Scheme | Indifferent | |
| ORC-12.13 | Identifier Type Code | Indifferent | |
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | wcEHR | Presence-Content Indifferent |
| ORC-17.2 | Text | West Clinic | Presence-Content Indifferent |
| ORC-17.3 | Name of Coding System | HL70362 | Value-Profile Fixed |
| ORC-17.5 | Alternate Text | Indifferent | |
| ORC-17.6 | Name of Alternate Coding System | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | Value-Profile Fixed |
| RXA-2 | Administration Sub-ID Counter | 1 | Value-Profile Fixed |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20141021 | Presence-Content Indifferent |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 152 | Value-Test Case Fixed |
| RXA-5.2 | Text | Pneumococcal Conjugate, unspecified formulation | Presence-Content Indifferent |
| RXA-5.3 | Name of Coding System | CVX | Value-Test Case Fixed |
| RXA-5.5 | Alternate Text | Indifferent | |
| RXA-5.6 | Name of Alternate Coding System | Indifferent | |
| RXA-6 | Administered Amount | 999 | Value-Test Case Fixed |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | NonPresence | |
| RXA-7.2 | Text | NonPresence | |
| RXA-7.3 | Name of Coding System | NonPresence | |
| RXA-7.5 | Alternate Text | NonPresence | |
| RXA-7.6 | Name of Alternate Coding System | NonPresence | |
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 01 | Value-Test Case Fixed |
| RXA-9.2 | Text | Historical Administration | Presence-Content Indifferent |
| RXA-9.3 | Name of Coding System | NIP001 | Value-Profile Fixed |
| RXA-9.5 | Alternate Text | Indifferent | |
| RXA-9.6 | Name of Alternate Coding System | Indifferent | |
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | Indifferent | |
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Indifferent | |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Indifferent | |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | Indifferent | |
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | Indifferent | |
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | Indifferent | |
| RXA-10.12 | Check Digit Scheme | Indifferent | |
| RXA-10.13 | Identifier Type Code | Indifferent | |
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | Indifferent | |
| RXA-11.4.2 | Universal ID | Indifferent | |
| RXA-11.4.3 | Universal ID Type | Indifferent | |
| RXA-15 | Substance Lot Number | Indifferent | |
| RXA-16 | Substance Expiration Date | ||
| RXA-16.1 | Time | Indifferent | |
| RXA-17 | Substance Manufacturer Name | ||
| RXA-17.1 | Identifier | Indifferent | |
| RXA-17.2 | Text | Indifferent | |
| RXA-17.3 | Name of Coding System | Indifferent | |
| RXA-17.5 | Alternate Text | Indifferent | |
| RXA-17.6 | Name of Alternate Coding System | Indifferent | |
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | Indifferent | |
| RXA-18.2 | Text | Indifferent | |
| RXA-18.3 | Name of Coding System | Indifferent | |
| RXA-18.5 | Alternate Text | Indifferent | |
| RXA-18.6 | Name of Alternate Coding System | Indifferent | |
| RXA-20 | Completion Status | CP | Value-Test Case Fixed |
| RXA-21 | Action Code - RXA | A | Value-Test Case Fixed |
| Element | Data |
|---|---|
| Patient Name | Manuel Diego Vasquez |
| Mother's Maiden Name | |
| ID Number | 21142 |
| Date/Time of Birth | 02/15/1947 |
| Administrative Sex | Male |
| Patient Address | 227 Park Ave Bozeman MT 59715 USA |
| Local Number | (406)555-5815 |
| Manuel.Vasquez@isp.com | |
| Race | White |
| Ethnic Group | Hispanic or Latino |
| Multiple Birth Indicator | N |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 06/25/2015 |
| Publicity Code | No reminder/recall |
| Publicity Code Effective Date | 06/25/2015 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 06/25/2015 |
| Element | Data |
|---|---|
| Administered Code | Pneumococcal Conjugate, unspecified formulation |
| Date/Time Start of Administration | 10/21/2014 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical Administration |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By |
| Element | Data |
|---|---|
| Patient Name | Manuel Diego Vasquez |
| Mother's Maiden Name | |
| ID Number | 21142 |
| Date/Time of Birth | 02/15/1947 |
| Administrative Sex | Male |
| Patient Address | 227 Park Ave Bozeman MT 59715 USA |
| Local Number | (406)555-5815 |
| Manuel.Vasquez@isp.com | |
| Race | White |
| Ethnic Group | Hispanic or Latino |
| Multiple Birth Indicator | N |
| Birth Order | 1 |
| Element | Data |
|---|---|
| Immunization Registry Status | A |
| Immunization Registry Status Effective Date | 06/25/2015 |
| Publicity Code | No reminder/recall |
| Publicity Code Effective Date | 06/25/2015 |
| Protection Indicator | No |
| Protection Indicator Effective Date | 06/25/2015 |
| Element | Data |
|---|---|
| Administered Code | Pneumococcal Conjugate, unspecified formulation |
| Date/Time Start of Administration | 10/21/2014 |
| Administered Amount | 999 |
| Administered Units | |
| Administration Notes | Historical Administration |
| Administering Provider | |
| Substance Lot Number | |
| Substance Expiration Date | |
| Substance Manufacturer Name | |
| Substance/Treatment Refusal Reason | |
| Completion Status | CP |
| Action Code | Add |
| Route | |
| Administration Site | |
| Entering Organization | West Clinic |
| Entered By | Lily Jackson |
| Ordered By |
| Description |
|---|
| Due to an error in the IIS software, the IIS is unable to recognize the HL7 version ID sent in MSH-12 even though it is valid. The acknowledgement message returned contains an error for an unsupported version ID. |
| Comments |
|---|
| No Comments |
| Pre Condition |
|---|
| A VXU message is generated by the EHR. |
| Post Condition |
|---|
| No PostCondition |
| Test Objectives |
|---|
| Evaluation Criteria |
|---|
| The error returned in the acknowledgement message is visible in the system responsible for the content of the administration message. |
| Notes for Testers |
|---|
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | iisApp | Presence-Content Indifferent |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | IIS | Presence-Content Indifferent |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | wcApp | Presence-Content Indifferent |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150625072816.602-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | ACK | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | ACK | Value-Profile Fixed |
| MSH-10 | Message Control ID | 48026 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z23 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | IIS | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | Indifferent | |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | Indifferent | |
| MSH-22.10 | Organization Identifier | Indifferent | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | wcEHR | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | Indifferent | |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | Indifferent | |
| MSH-23.10 | Organization Identifier | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA-1 | Acknowledgment Code | AR | Value-Test Case Fixed |
| MSA-2 | Message Control ID | 41821 | Presence-System Generated |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ERR-2 | Error Location | ||
| ERR-2.1 | Segment ID | MSH | Value-Test Case Fixed |
| ERR-2.2 | Segment Sequence | 12 | Value-Test Case Fixed |
| ERR-2.3 | Field Position | 1 | Value-Test Case Fixed |
| ERR-2.4 | Field Repetition | 1 | Value-Test Case Fixed |
| ERR-2.5 | Component Number | Indifferent | |
| ERR-2.6 | Sub-Component Number | Indifferent | |
| ERR-3 | HL7 Error Code | ||
| ERR-3.1 | Identifier | 203 | Value-Test Case Fixed |
| ERR-3.2 | Text | Unsupported Version ID | Presence-Content Indifferent |
| ERR-3.3 | Name of Coding System | HL70357 | Value-Profile Fixed |
| ERR-3.5 | Alternate Text | Indifferent | |
| ERR-3.6 | Name of Alternate Coding System | Indifferent | |
| ERR-4 | Severity | E | Value-Test Case Fixed |
| ERR-5 | Application Error Code | ||
| ERR-5.1 | Identifier | Indifferent | |
| ERR-5.2 | Text | Indifferent | |
| ERR-5.3 | Name of Coding System | Indifferent | |
| ERR-5.5 | Alternate Text | Indifferent | |
| ERR-5.6 | Name of Alternate Coding System | Indifferent | |
| ERR-8 | User Message | Version ID not recognized - message rejected | Presence-Content Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | iisApp | Presence-Content Indifferent |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | IIS | Presence-Content Indifferent |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | wcApp | Presence-Content Indifferent |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | wcEHR | Presence-Content Indifferent |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150625072816.602-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | ACK | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | V04 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | ACK | Value-Profile Fixed |
| MSH-10 | Message Control ID | 48026 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | NE | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z23 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Test Case Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | IIS | Presence-Content Indifferent |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | Indifferent | |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | Indifferent | |
| MSH-22.10 | Organization Identifier | Indifferent | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | wcEHR | Presence-Content Indifferent |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | Indifferent | |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | Indifferent | |
| MSH-23.10 | Organization Identifier | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA-1 | Acknowledgment Code | AR | Value-Test Case Fixed |
| MSA-2 | Message Control ID | 41821 | Presence-System Generated |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ERR-2 | Error Location | ||
| ERR-2.1 | Segment ID | MSH | Value-Test Case Fixed |
| ERR-2.2 | Segment Sequence | 12 | Value-Test Case Fixed |
| ERR-2.3 | Field Position | 1 | Value-Test Case Fixed |
| ERR-2.4 | Field Repetition | 1 | Value-Test Case Fixed |
| ERR-2.5 | Component Number | Indifferent | |
| ERR-2.6 | Sub-Component Number | Indifferent | |
| ERR-3 | HL7 Error Code | ||
| ERR-3.1 | Identifier | 203 | Value-Test Case Fixed |
| ERR-3.2 | Text | Unsupported Version ID | Presence-Content Indifferent |
| ERR-3.3 | Name of Coding System | HL70357 | Value-Profile Fixed |
| ERR-3.5 | Alternate Text | Indifferent | |
| ERR-3.6 | Name of Alternate Coding System | Indifferent | |
| ERR-4 | Severity | E | Value-Test Case Fixed |
| ERR-5 | Application Error Code | ||
| ERR-5.1 | Identifier | Indifferent | |
| ERR-5.2 | Text | Indifferent | |
| ERR-5.3 | Name of Coding System | Indifferent | |
| ERR-5.5 | Alternate Text | Indifferent | |
| ERR-5.6 | Name of Alternate Coding System | Indifferent | |
| ERR-8 | User Message | Version ID not recognized - message rejected | Presence-Content Indifferent |
| Return an Acknowledgement | |||||
|---|---|---|---|---|---|
| Test Case ID | IZ-AD-10_Historical_IIS-SysError | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement (Pass/Fail) |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the health information technology's ability to receive and process a Return an Acknowledgement Z23 message (in response to a "Send Unsolicited Immunization Update Using a VXU" Z22 message) in which an Error is returned in the message.
The exact wording and format of the display in the health information technology (HIT) is not in-scope for this test.
| Return an Acknowledgement |
|---|
|
The receiving HIT system being tested shall process the Z23 ACK error notification message correctly; the issue identified in the error notification must be made visible in the system. |
(1) create query
messages based on Immunization Messaging Standard (Z44 Profile) and specific
Test Data, and
(2) receive (Z42 Profile) messages and display evaluated history and forecast OR receive (Z33 Profile) and? display too many patients found or no patients found.
| Description |
|---|
| A male child patient, Bobbie Q. Child, is brought to the clinic for an annual visit. A staff person locates his medical record in the EHR-S. The staff person confirms demographic information, including address. The staff person triggers a request to the IIS for an evaluated history and forecast for the child. The IIS performs a search for Bobbie Q. Child and finds one high-confidence match. The IIS generates an evaluated history and forecast for Bobbie and returns this to the EHR-S. One dose of vaccine was not administrated at the correct age and is marked as not valid. The EHR-S displays the evaluated history and forecast, including the not valid dose. |
| Comments |
|---|
| No Comments |
| Pre Condition |
|---|
| Person exists in the querying system with the complete demographics as provided in the Test Data Specification. Person has Medical Record Number (MR). Person does not have existing immunization events in their EHR. Person does have an immunization history in the IIS (simulated by the NIST Test Tool). |
| Post Condition |
|---|
| The clinician is able to view the evaluated history and forecast from the IIS. There is no obligation to incorporate the data into the EHR-S or maintain the displayed evaluated history and forecast. |
| Test Objectives |
|---|
| Evaluates EHR-S ability to create a well formed query for a child. Evaluates EHR-S ability to accept and display a response with evaluated history and forecast for that person. |
| Evaluation Criteria |
|---|
| Tester inspects patient record; confirms that the patients does not have existing immunization events. Confirms valid query message using Message Validation Report. Confirms valid receipt and display of response message using the Juror Document. |
| Notes for Testers |
|---|
| The NIST tool is simulating a response from the IIS. |
| Description |
|---|
| A male child patient, Bobbie Q. Child, is brought to the clinic for an annual visit. A staff person locates his medical record in the EHR-S. The staff person confirms demographic information, including address. The Staff person triggers a request to the IIS for an evaluated history and forecast for the child. |
| Comments |
|---|
| Most of the test data is categorized as Test Case Fixed. It is important that the data is entered into the querying system as specified to enable linking the response message to the patient record. |
| Pre Condition |
|---|
| Person exists in the system with the complete demographics as provided in the Test Data Specification. Person has Medical Record Number (MR). Person does not have existing immunization events in their EHR. Person does have an immunization history in the IIS. |
| Post Condition |
|---|
| The IIS return an evaluated history and forecast for the person. |
| Test Objectives |
|---|
| Test the ability of the system to successfully create a query message based on the given test data. |
| Evaluation Criteria |
|---|
| Tester inspects patient record; confirms that the patients does not have existing immunization events. Confirms valid query message using Message Validation Report. |
| Notes for Testers |
|---|
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | NIST EHR APP | Presence-Configuration |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | NIST EHR Facility | Presence-Configuration |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | NIST IIS APP | Presence-Configuration |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | NIST IIS FAC | Presence-Configuration |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20141031145233-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | QBP | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | Q11 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | QBP_Q11 | Value-Profile Fixed |
| MSH-10 | Message Control ID | NIST-IZ-QR-1.1_Query_Q11_Z44 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | ER | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | AL | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z44 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Profile Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | NIST EHR Facility | Presence-Configuration |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | NIST-AA-1 | Indifferent |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | XX | Indifferent |
| MSH-22.10 | Organization Identifier | 100-6482 | Indifferent |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | NIST IIS FAC | Presence-Configuration |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | NIST-AA-1 | Indifferent |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | XX | Indifferent |
| MSH-23.10 | Organization Identifier | 100-1776 | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD-1 | Message Query Name | ||
| QPD-1.1 | Identifier | Z44 | Value-Test Case Fixed |
| QPD-1.2 | Text | Request Evaluated History and Forecast | Value-Test Case Fixed |
| QPD-1.3 | Name of Coding System | CDCPHINVS | Value-Profile Fixed |
| QPD-1.5 | Alternate Text | ||
| QPD-1.6 | Name of Alternate Coding System | ||
| QPD-2 | Query Tag | IZ-1.1-2015 | Presence-System Generated |
| QPD-3 | PatientList | ||
| QPD-3.1 | ID Number | 171122 | Value-Test Case Fixed |
| QPD-3.3 | Check Digit Scheme | ||
| QPD-3.4 | Assigning Authority | ||
| QPD-3.4.1 | Namespace ID | NIST MPI | Value-Test Case Fixed |
| QPD-3.4.2 | Universal ID | Indifferent | |
| QPD-3.4.3 | Universal ID Type | Indifferent | |
| QPD-3.5 | Identifier Type Code | MR | Value-Test Case Fixed |
| QPD-4 | PatientName | ||
| QPD-4.1 | Family Name | ||
| QPD-4.1.1 | Surname | Child | Value-Test Case Fixed |
| QPD-4.1.2 | Own Surname Prefix | ||
| QPD-4.1.3 | Own Surname | ||
| QPD-4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD-4.1.5 | Surname From Partner/Spouse | ||
| QPD-4.2 | Given Name | Bobbie | Value-Test Case Fixed |
| QPD-4.3 | Second and Further Given Names or Initials Thereof | Q | Value-Test Case Fixed |
| QPD-4.7 | Name Type Code | L | Value-Test Case Fixed |
| QPD-5 | PatientMotherMaidenName | ||
| QPD-5.1 | Family Name | ||
| QPD-5.1.1 | Surname | Que | Value-Test Case Fixed |
| QPD-5.1.2 | Own Surname Prefix | ||
| QPD-5.1.3 | Own Surname | ||
| QPD-5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD-5.1.5 | Surname From Partner/Spouse | ||
| QPD-5.7 | Name Type Code | M | Value-Profile Fixed |
| QPD-6 | PatientDateOfBirth | ||
| QPD-6.1 | Time | 20090214 | Value-Test Case Fixed |
| QPD-7 | Patient Sex | M | Value-Test Case Fixed |
| QPD-8 | Patient Address | ||
| QPD-8.1 | Street Address | ||
| QPD-8.1.1 | Street or Mailing Address | 105 Laurel Run Rd | Value-Test Case Fixed |
| QPD-8.1.2 | Street Name | ||
| QPD-8.1.3 | Dwelling Number | ||
| QPD-8.2 | Other Designation | Indifferent | |
| QPD-8.3 | City | Bozeman | Value-Test Case Fixed |
| QPD-8.4 | State or Province | MT | Value-Test Case Fixed |
| QPD-8.5 | Zip or Postal Code | Value-Test Case Fixed | |
| QPD-8.6 | Country | Value-Test Case Fixed | |
| QPD-8.7 | Address Type | L | Presence-Content Indifferent |
| QPD-9 | Phone | ||
| QPD-9.2 | Telecommunication Use Code | Value-Test Case Fixed | |
| QPD-9.3 | Telecommunication Equipment Type | Value-Test Case Fixed | |
| QPD-9.4 | Email Address | ||
| QPD-9.6 | Area/City Code | Value-Test Case Fixed | |
| QPD-9.7 | Local Number | Value-Test Case Fixed | |
| QPD-10 | Multiple birth indicator | Value-Test Case Fixed | |
| QPD-11 | Birth order | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RCP-1 | Query Priority | I | Value-Profile Fixed |
| RCP-2 | Quantity Limited Request | ||
| RCP-2.1 | Quantity | 1 | Value-Test Case Fixed |
| RCP-2.2 | Units | ||
| RCP-2.2.1 | Identifier | RD | Value-Profile Fixed |
| RCP-2.2.2 | Text | Records | Value-Profile Fixed |
| RCP-2.2.3 | Name of Coding System | HL70126 | Value-Profile Fixed |
| RCP-2.2.4 | Alternate Identifier | ||
| RCP-2.2.5 | Alternate Text | ||
| RCP-2.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | NIST EHR APP | Presence-Configuration |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | NIST EHR Facility | Presence-Configuration |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | NIST IIS APP | Presence-Configuration |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | NIST IIS FAC | Presence-Configuration |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20141031145233-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | QBP | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | Q11 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | QBP_Q11 | Value-Profile Fixed |
| MSH-10 | Message Control ID | NIST-IZ-QR-1.1_Query_Q11_Z44 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | ER | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | AL | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z44 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Profile Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | NIST EHR Facility | Presence-Configuration |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | NIST-AA-1 | Indifferent |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | XX | Indifferent |
| MSH-22.10 | Organization Identifier | 100-6482 | Indifferent |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | NIST IIS FAC | Presence-Configuration |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | NIST-AA-1 | Indifferent |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | XX | Indifferent |
| MSH-23.10 | Organization Identifier | 100-1776 | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD-1 | Message Query Name | ||
| QPD-1.1 | Identifier | Z44 | Value-Test Case Fixed |
| QPD-1.2 | Text | Request Evaluated History and Forecast | Value-Test Case Fixed |
| QPD-1.3 | Name of Coding System | CDCPHINVS | Value-Profile Fixed |
| QPD-1.5 | Alternate Text | ||
| QPD-1.6 | Name of Alternate Coding System | ||
| QPD-2 | Query Tag | IZ-1.1-2015 | Presence-System Generated |
| QPD-3 | PatientList | ||
| QPD-3.1 | ID Number | 171122 | Value-Test Case Fixed |
| QPD-3.3 | Check Digit Scheme | ||
| QPD-3.4 | Assigning Authority | ||
| QPD-3.4.1 | Namespace ID | NIST MPI | Value-Test Case Fixed |
| QPD-3.4.2 | Universal ID | Indifferent | |
| QPD-3.4.3 | Universal ID Type | Indifferent | |
| QPD-3.5 | Identifier Type Code | MR | Value-Test Case Fixed |
| QPD-4 | PatientName | ||
| QPD-4.1 | Family Name | ||
| QPD-4.1.1 | Surname | Child | Value-Test Case Fixed |
| QPD-4.1.2 | Own Surname Prefix | ||
| QPD-4.1.3 | Own Surname | ||
| QPD-4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD-4.1.5 | Surname From Partner/Spouse | ||
| QPD-4.2 | Given Name | Bobbie | Value-Test Case Fixed |
| QPD-4.3 | Second and Further Given Names or Initials Thereof | Q | Value-Test Case Fixed |
| QPD-4.7 | Name Type Code | L | Value-Test Case Fixed |
| QPD-5 | PatientMotherMaidenName | ||
| QPD-5.1 | Family Name | ||
| QPD-5.1.1 | Surname | Que | Value-Test Case Fixed |
| QPD-5.1.2 | Own Surname Prefix | ||
| QPD-5.1.3 | Own Surname | ||
| QPD-5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD-5.1.5 | Surname From Partner/Spouse | ||
| QPD-5.7 | Name Type Code | M | Value-Profile Fixed |
| QPD-6 | PatientDateOfBirth | ||
| QPD-6.1 | Time | 20090214 | Value-Test Case Fixed |
| QPD-7 | Patient Sex | M | Value-Test Case Fixed |
| QPD-8 | Patient Address | ||
| QPD-8.1 | Street Address | ||
| QPD-8.1.1 | Street or Mailing Address | 105 Laurel Run Rd | Value-Test Case Fixed |
| QPD-8.1.2 | Street Name | ||
| QPD-8.1.3 | Dwelling Number | ||
| QPD-8.2 | Other Designation | Indifferent | |
| QPD-8.3 | City | Bozeman | Value-Test Case Fixed |
| QPD-8.4 | State or Province | MT | Value-Test Case Fixed |
| QPD-8.5 | Zip or Postal Code | Value-Test Case Fixed | |
| QPD-8.6 | Country | Value-Test Case Fixed | |
| QPD-8.7 | Address Type | L | Presence-Content Indifferent |
| QPD-9 | Phone | ||
| QPD-9.2 | Telecommunication Use Code | Value-Test Case Fixed | |
| QPD-9.3 | Telecommunication Equipment Type | Value-Test Case Fixed | |
| QPD-9.4 | Email Address | ||
| QPD-9.6 | Area/City Code | Value-Test Case Fixed | |
| QPD-9.7 | Local Number | Value-Test Case Fixed | |
| QPD-10 | Multiple birth indicator | Value-Test Case Fixed | |
| QPD-11 | Birth order | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RCP-1 | Query Priority | I | Value-Profile Fixed |
| RCP-2 | Quantity Limited Request | ||
| RCP-2.1 | Quantity | 1 | Value-Test Case Fixed |
| RCP-2.2 | Units | ||
| RCP-2.2.1 | Identifier | RD | Value-Profile Fixed |
| RCP-2.2.2 | Text | Records | Value-Profile Fixed |
| RCP-2.2.3 | Name of Coding System | HL70126 | Value-Profile Fixed |
| RCP-2.2.4 | Alternate Identifier | ||
| RCP-2.2.5 | Alternate Text | ||
| RCP-2.2.6 | Name of Alternate Coding System |
| Element | Data |
|---|---|
| Patient Name | Bobbie Q Child |
| Mother's Maiden Name | Que |
| ID Number | 171122 |
| Date/Time of Birth | 02/14/2009 |
| Sex | Male |
| Patient Address | 105 Laurel Run Rd Bozeman MT |
| Patient Phone | |
| Birth Indicator | |
| Birth Order |
| Element | Data |
|---|---|
| Patient Name | Bobbie Q Child |
| Mother's Maiden Name | Que |
| ID Number | 171122 |
| Date/Time of Birth | 02/14/2009 |
| Sex | Male |
| Patient Address | 105 Laurel Run Rd Bozeman MT |
| Patient Phone | |
| Birth Indicator | |
| Birth Order |
| Description |
|---|
| The IIS performs a search for Bobbie Q. Child and finds one high-confidence match. The IIS generates an evaluated history and forecast for Bobbie and returns this to the EHR-S. One dose of vaccine was not administrated at the correct age and is marked as not valid. The EHR-S displays the evaluated history and forecast, including the not valid dose. |
| Comments |
|---|
| No Comments |
| Pre Condition |
|---|
| A query is performed by the sending system. The IIS (simulated by the NIST test tool) contains an immunization events for the person. |
| Post Condition |
|---|
| The response is made available to the EHR-S for processing. The clinician is able to view the evaluated history and forecast from the IIS. There is no obligation to incorporate the data into the EHR-S or maintain the displayed evaluated history and forecast. |
| Test Objectives |
|---|
| Receive a response message containing the evaluated history and forecast; display evaluated history and forecast. |
| Evaluation Criteria |
|---|
| Confirms valid receipt and display of response message using the Juror Document. |
| Notes for Testers |
|---|
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | |
| MSH-2 | Encoding Characters | ^~\& | |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | NIST IIS APP | |
| MSH-3.2 | Universal ID | ||
| MSH-3.3 | Universal ID Type | ||
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | NIST IIS FAC | |
| MSH-4.2 | Universal ID | ||
| MSH-4.3 | Universal ID Type | ||
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | NIST EHR APP | |
| MSH-5.2 | Universal ID | ||
| MSH-5.3 | Universal ID Type | ||
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | NIST EHR Facility | |
| MSH-6.2 | Universal ID | ||
| MSH-6.3 | Universal ID Type | ||
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20151031145233-0500 | |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | RSP | |
| MSH-9.2 | Trigger Event | K11 | |
| MSH-9.3 | Message Structure | RSP_K11 | |
| MSH-10 | Message Control ID | NIST-IZ-QR-1.2_Response_K11_Z42 | |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | |
| MSH-15 | Accept Acknowledgment Type | NE | |
| MSH-16 | Application Acknowledgment Type | NE | |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z42 | |
| MSH-21.2 | Namespace ID | CDCPHINVS | |
| MSH-21.3 | Universal ID | ||
| MSH-21.4 | Universal ID Type | ||
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | NIST IIS FAC | |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | NIST-AA-1 | |
| MSH-22.6.2 | Universal ID | ||
| MSH-22.6.3 | Universal ID Type | ||
| MSH-22.7 | Identifier Type Code | XX | |
| MSH-22.10 | Organization Identifier | 100-1776 | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | NIST EHR Facility | |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | NIST-AA-1 | |
| MSH-23.6.2 | Universal ID | ||
| MSH-23.6.3 | Universal ID Type | ||
| MSH-23.7 | Identifier Type Code | XX | |
| MSH-23.10 | Organization Identifier | 100-6482 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA-1 | Acknowledgment Code | AA | |
| MSA-2 | Message Control ID | NIST-IZ-QR-1.1_Query_Q11_Z44 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QAK-1 | Query Tag | IZ-1.1-2015 | |
| QAK-2 | Query Response Status | OK | |
| QAK-3 | Message Query Name | ||
| QAK-3.1 | Identifier | Z44 | |
| QAK-3.2 | Text | request evaluated Immunization history | |
| QAK-3.3 | Name of Coding System | CDCPHINVS | |
| QAK-3.5 | Alternate Text | ||
| QAK-3.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD-1 | Message Query Name | ||
| QPD-1.1 | Identifier | Z44 | |
| QPD-1.2 | Text | Request Evaluated History and Forecast | |
| QPD-1.3 | Name of Coding System | CDCPHINVS | |
| QPD-1.5 | Alternate Text | ||
| QPD-1.6 | Name of Alternate Coding System | ||
| QPD-2 | Query Tag | 107374859 | |
| QPD-3 | PatientList | ||
| QPD-3.1 | ID Number | 171122 | |
| QPD-3.3 | Check Digit Scheme | ||
| QPD-3.4 | Assigning Authority | ||
| QPD-3.4.1 | Namespace ID | NIST MPI | |
| QPD-3.4.2 | Universal ID | ||
| QPD-3.4.3 | Universal ID Type | ||
| QPD-3.5 | Identifier Type Code | MR | |
| QPD-4 | PatientName | ||
| QPD-4.1 | Family Name | ||
| QPD-4.1.1 | Surname | Child | |
| QPD-4.1.2 | Own Surname Prefix | ||
| QPD-4.1.3 | Own Surname | ||
| QPD-4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD-4.1.5 | Surname From Partner/Spouse | ||
| QPD-4.2 | Given Name | Bobbie | |
| QPD-4.3 | Second and Further Given Names or Initials Thereof | Q | |
| QPD-4.7 | Name Type Code | L | |
| QPD-5 | PatientMotherMaidenName | ||
| QPD-5.1 | Family Name | ||
| QPD-5.1.1 | Surname | Que | |
| QPD-5.1.2 | Own Surname Prefix | ||
| QPD-5.1.3 | Own Surname | ||
| QPD-5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD-5.1.5 | Surname From Partner/Spouse | ||
| QPD-5.7 | Name Type Code | M | |
| QPD-6 | PatientDateOfBirth | ||
| QPD-6.1 | Time | 20090214 | |
| QPD-7 | Patient Sex | M | |
| QPD-8 | Patient Address | ||
| QPD-8.1 | Street Address | ||
| QPD-8.1.1 | Street or Mailing Address | 105 Laurel Run Rd | |
| QPD-8.1.2 | Street Name | ||
| QPD-8.1.3 | Dwelling Number | ||
| QPD-8.2 | Other Designation | ||
| QPD-8.3 | City | Bozeman | |
| QPD-8.4 | State or Province | MT | |
| QPD-8.5 | Zip or Postal Code | ||
| QPD-8.6 | Country | ||
| QPD-8.7 | Address Type | L | |
| QPD-9 | Phone | ||
| QPD-9.2 | Telecommunication Use Code | ||
| QPD-9.3 | Telecommunication Equipment Type | ||
| QPD-9.4 | Email Address | ||
| QPD-9.6 | Area/City Code | ||
| QPD-9.7 | Local Number | ||
| QPD-10 | Multiple birth indicator | ||
| QPD-11 | Birth order |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID-1 | Set ID - PID | 1 | |
| PID-3[1] | Patient Identifier List | ||
| PID-3[1].1 | ID Number | 171122 | |
| PID-3[1].3 | Check Digit Scheme | ||
| PID-3[1].4 | Assigning Authority | ||
| PID-3[1].4.1 | Namespace ID | NIST MPI | |
| PID-3[1].4.2 | Universal ID | ||
| PID-3[1].4.3 | Universal ID Type | ||
| PID-3[1].5 | Identifier Type Code | MR | |
| PID-3[2] | Patient Identifier List | ||
| PID-3[2].1 | ID Number | 34500907 | |
| PID-3[2].3 | Check Digit Scheme | ||
| PID-3[2].4 | Assigning Authority | ||
| PID-3[2].4.1 | Namespace ID | MyIIS | |
| PID-3[2].4.2 | Universal ID | ||
| PID-3[2].4.3 | Universal ID Type | ||
| PID-3[2].5 | Identifier Type Code | SR | |
| PID-5 | Patient Name | ||
| PID-5.1 | Family Name | ||
| PID-5.1.1 | Surname | Child | |
| PID-5.1.2 | Own Surname Prefix | ||
| PID-5.1.3 | Own Surname | ||
| PID-5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-5.1.5 | Surname From Partner/Spouse | ||
| PID-5.2 | Given Name | Bobbie | |
| PID-5.3 | Second and Further Given Names or Initials Thereof | Q | |
| PID-5.7 | Name Type Code | L | |
| PID-7 | Date/Time of Birth | ||
| PID-7.1 | Time | 20090214 | |
| PID-8 | Administrative Sex | M | |
| PID-11 | Patient Address | ||
| PID-11.1 | Street Address | ||
| PID-11.1.1 | Street or Mailing Address | 105 Laurel Run Rd | |
| PID-11.1.2 | Street Name | ||
| PID-11.1.3 | Dwelling Number | ||
| PID-11.2 | Other Designation | ||
| PID-11.3 | City | Bozeman | |
| PID-11.4 | State or Province | MT | |
| PID-11.5 | Zip or Postal Code | ||
| PID-11.6 | Country | ||
| PID-11.7 | Address Type | L | |
| PID-30 | Patient Death Indicator |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | ||
| ORC-2.2 | Namespace ID | ||
| ORC-2.3 | Universal ID | ||
| ORC-2.4 | Universal ID Type | ||
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 197023 | |
| ORC-3.2 | Namespace ID | NIST-AA-1 | |
| ORC-3.3 | Universal ID | ||
| ORC-3.4 | Universal ID Type | ||
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | wc | |
| ORC-17.2 | Text | West Clinic | |
| ORC-17.3 | Name of Coding System | HL70362 | |
| ORC-17.5 | Alternate Text | ||
| ORC-17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | ||
| ORC-2.2 | Namespace ID | ||
| ORC-2.3 | Universal ID | ||
| ORC-2.4 | Universal ID Type | ||
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 197027 | |
| ORC-3.2 | Namespace ID | DCS | |
| ORC-3.3 | Universal ID | ||
| ORC-3.4 | Universal ID Type | ||
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | ||
| ORC-17.2 | Text | ||
| ORC-17.3 | Name of Coding System | ||
| ORC-17.5 | Alternate Text | ||
| ORC-17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | ||
| ORC-2.2 | Namespace ID | ||
| ORC-2.3 | Universal ID | ||
| ORC-2.4 | Universal ID Type | ||
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 197028 | |
| ORC-3.2 | Namespace ID | DCS | |
| ORC-3.3 | Universal ID | ||
| ORC-3.4 | Universal ID Type | ||
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | ||
| ORC-17.2 | Text | ||
| ORC-17.3 | Name of Coding System | ||
| ORC-17.5 | Alternate Text | ||
| ORC-17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | ||
| ORC-2.2 | Namespace ID | ||
| ORC-2.3 | Universal ID | ||
| ORC-2.4 | Universal ID Type | ||
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 197028 | |
| ORC-3.2 | Namespace ID | DCS | |
| ORC-3.3 | Universal ID | ||
| ORC-3.4 | Universal ID Type | ||
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | ||
| ORC-17.2 | Text | ||
| ORC-17.3 | Name of Coding System | ||
| ORC-17.5 | Alternate Text | ||
| ORC-17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | ||
| ORC-2.2 | Namespace ID | ||
| ORC-2.3 | Universal ID | ||
| ORC-2.4 | Universal ID Type | ||
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 197028 | |
| ORC-3.2 | Namespace ID | DCS | |
| ORC-3.3 | Universal ID | ||
| ORC-3.4 | Universal ID Type | ||
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | ||
| ORC-17.2 | Text | ||
| ORC-17.3 | Name of Coding System | ||
| ORC-17.5 | Alternate Text | ||
| ORC-17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | ||
| ORC-2.2 | Namespace ID | ||
| ORC-2.3 | Universal ID | ||
| ORC-2.4 | Universal ID Type | ||
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 9999 | |
| ORC-3.2 | Namespace ID | DCS | |
| ORC-3.3 | Universal ID | ||
| ORC-3.4 | Universal ID Type | ||
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | DCS | |
| ORC-17.2 | Text | Dabig Clinical System | |
| ORC-17.3 | Name of Coding System | HL70362 | |
| ORC-17.5 | Alternate Text | ||
| ORC-17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | |
| RXA-2 | Administration Sub-ID Counter | 1 | |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20090415 | |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 31 | |
| RXA-5.2 | Text | Hep B Peds NOS | |
| RXA-5.3 | Name of Coding System | CVX | |
| RXA-5.5 | Alternate Text | ||
| RXA-5.6 | Name of Alternate Coding System | ||
| RXA-6 | Administered Amount | 999 | |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | ||
| RXA-7.2 | Text | ||
| RXA-7.3 | Name of Coding System | ||
| RXA-7.5 | Alternate Text | ||
| RXA-7.6 | Name of Alternate Coding System | ||
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 01 | |
| RXA-9.2 | Text | historical record | |
| RXA-9.3 | Name of Coding System | NIP001 | |
| RXA-9.5 | Alternate Text | ||
| RXA-9.6 | Name of Alternate Coding System | ||
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | ||
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | ||
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | ||
| RXA-10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | ||
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | ||
| RXA-10.12 | Check Digit Scheme | ||
| RXA-10.13 | Identifier Type Code | ||
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | ||
| RXA-11.4.2 | Universal ID | ||
| RXA-11.4.3 | Universal ID Type | ||
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | ||
| RXA-18.2 | Text | ||
| RXA-18.3 | Name of Coding System | ||
| RXA-18.5 | Alternate Text | ||
| RXA-18.6 | Name of Alternate Coding System | ||
| RXA-20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | |
| RXA-2 | Administration Sub-ID Counter | 1 | |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20090314 | |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 48 | |
| RXA-5.2 | Text | HIB PRP-T | |
| RXA-5.3 | Name of Coding System | CVX | |
| RXA-5.5 | Alternate Text | ||
| RXA-5.6 | Name of Alternate Coding System | ||
| RXA-6 | Administered Amount | 999 | |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | ||
| RXA-7.2 | Text | ||
| RXA-7.3 | Name of Coding System | ||
| RXA-7.5 | Alternate Text | ||
| RXA-7.6 | Name of Alternate Coding System | ||
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 01 | |
| RXA-9.2 | Text | historic immunization record | |
| RXA-9.3 | Name of Coding System | NIP001 | |
| RXA-9.5 | Alternate Text | ||
| RXA-9.6 | Name of Alternate Coding System | ||
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | ||
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Sticker | |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Nurse | |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | ||
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | ||
| RXA-10.12 | Check Digit Scheme | ||
| RXA-10.13 | Identifier Type Code | ||
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | DCS_DC | |
| RXA-11.4.2 | Universal ID | ||
| RXA-11.4.3 | Universal ID Type | ||
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | ||
| RXA-18.2 | Text | ||
| RXA-18.3 | Name of Coding System | ||
| RXA-18.5 | Alternate Text | ||
| RXA-18.6 | Name of Alternate Coding System | ||
| RXA-20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | |
| RXA-2 | Administration Sub-ID Counter | 1 | |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20091011 | |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 110 | |
| RXA-5.2 | Text | DTAP-Hep B-IPV | |
| RXA-5.3 | Name of Coding System | CVX | |
| RXA-5.5 | Alternate Text | ||
| RXA-5.6 | Name of Alternate Coding System | ||
| RXA-6 | Administered Amount | 999 | |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | ||
| RXA-7.2 | Text | ||
| RXA-7.3 | Name of Coding System | ||
| RXA-7.5 | Alternate Text | ||
| RXA-7.6 | Name of Alternate Coding System | ||
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 01 | |
| RXA-9.2 | Text | historic immunization record | |
| RXA-9.3 | Name of Coding System | NIP001 | |
| RXA-9.5 | Alternate Text | ||
| RXA-9.6 | Name of Alternate Coding System | ||
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | ||
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | ||
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | ||
| RXA-10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | ||
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | ||
| RXA-10.12 | Check Digit Scheme | ||
| RXA-10.13 | Identifier Type Code | ||
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | ||
| RXA-11.4.2 | Universal ID | ||
| RXA-11.4.3 | Universal ID Type | ||
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | ||
| RXA-18.2 | Text | ||
| RXA-18.3 | Name of Coding System | ||
| RXA-18.5 | Alternate Text | ||
| RXA-18.6 | Name of Alternate Coding System | ||
| RXA-20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | |
| RXA-2 | Administration Sub-ID Counter | 1 | |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20100411 | |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 08 | |
| RXA-5.2 | Text | Hep BPEDS | |
| RXA-5.3 | Name of Coding System | CVX | |
| RXA-5.5 | Alternate Text | ||
| RXA-5.6 | Name of Alternate Coding System | ||
| RXA-6 | Administered Amount | 999 | |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | ||
| RXA-7.2 | Text | ||
| RXA-7.3 | Name of Coding System | ||
| RXA-7.5 | Alternate Text | ||
| RXA-7.6 | Name of Alternate Coding System | ||
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 01 | |
| RXA-9.2 | Text | historic immunization record | |
| RXA-9.3 | Name of Coding System | NIP001 | |
| RXA-9.5 | Alternate Text | ||
| RXA-9.6 | Name of Alternate Coding System | ||
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | ||
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Sticker | |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Nurse | |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | ||
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | ||
| RXA-10.12 | Check Digit Scheme | ||
| RXA-10.13 | Identifier Type Code | ||
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | ||
| RXA-11.4.2 | Universal ID | ||
| RXA-11.4.3 | Universal ID Type | ||
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | ||
| RXA-18.2 | Text | ||
| RXA-18.3 | Name of Coding System | ||
| RXA-18.5 | Alternate Text | ||
| RXA-18.6 | Name of Alternate Coding System | ||
| RXA-20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | |
| RXA-2 | Administration Sub-ID Counter | 1 | |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20100415 | |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 03 | |
| RXA-5.2 | Text | MMR | |
| RXA-5.3 | Name of Coding System | CVX | |
| RXA-5.5 | Alternate Text | ||
| RXA-5.6 | Name of Alternate Coding System | ||
| RXA-6 | Administered Amount | 999 | |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | ||
| RXA-7.2 | Text | ||
| RXA-7.3 | Name of Coding System | ||
| RXA-7.5 | Alternate Text | ||
| RXA-7.6 | Name of Alternate Coding System | ||
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 01 | |
| RXA-9.2 | Text | historic immunization record | |
| RXA-9.3 | Name of Coding System | NIP001 | |
| RXA-9.5 | Alternate Text | ||
| RXA-9.6 | Name of Alternate Coding System | ||
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | ||
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | ||
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | ||
| RXA-10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | ||
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | ||
| RXA-10.12 | Check Digit Scheme | ||
| RXA-10.13 | Identifier Type Code | ||
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | ||
| RXA-11.4.2 | Universal ID | ||
| RXA-11.4.3 | Universal ID Type | ||
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | ||
| RXA-18.2 | Text | ||
| RXA-18.3 | Name of Coding System | ||
| RXA-18.5 | Alternate Text | ||
| RXA-18.6 | Name of Alternate Coding System | ||
| RXA-20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | |
| RXA-2 | Administration Sub-ID Counter | 1 | |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20091031 | |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 998 | |
| RXA-5.2 | Text | no vaccine admin | |
| RXA-5.3 | Name of Coding System | CVX | |
| RXA-5.5 | Alternate Text | ||
| RXA-5.6 | Name of Alternate Coding System | ||
| RXA-6 | Administered Amount | 999 | |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | ||
| RXA-7.2 | Text | ||
| RXA-7.3 | Name of Coding System | ||
| RXA-7.5 | Alternate Text | ||
| RXA-7.6 | Name of Alternate Coding System | ||
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | ||
| RXA-9.2 | Text | ||
| RXA-9.3 | Name of Coding System | ||
| RXA-9.5 | Alternate Text | ||
| RXA-9.6 | Name of Alternate Coding System | ||
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | ||
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | ||
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | ||
| RXA-10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | ||
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | ||
| RXA-10.12 | Check Digit Scheme | ||
| RXA-10.13 | Identifier Type Code | ||
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | ||
| RXA-11.4.2 | Universal ID | ||
| RXA-11.4.3 | Universal ID Type | ||
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | ||
| RXA-18.2 | Text | ||
| RXA-18.3 | Name of Coding System | ||
| RXA-18.5 | Alternate Text | ||
| RXA-18.6 | Name of Alternate Coding System | ||
| RXA-20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 1 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30956-7 | |
| OBX-3.2 | Text | vaccine type | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 2 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59779-9 | |
| OBX-3.2 | Text | Immunization Schedule used | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 3 | |
| OBX-2 | Value Type | ID | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59781-5 | |
| OBX-3.2 | Text | dose validity | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | Y | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 1 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30956-7 | |
| OBX-3.2 | Text | vaccine type | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 2 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59779-9 | |
| OBX-3.2 | Text | Immunization Schedule used | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 3 | |
| OBX-2 | Value Type | ID | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59781-5 | |
| OBX-3.2 | Text | dose validity | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | N | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 4 | |
| OBX-2 | Value Type | ST | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30982-3 | |
| OBX-3.2 | Text | Reason applied | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | Too Young | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 1 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30956-7 | |
| OBX-3.2 | Text | vaccine type | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 2 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59779-9 | |
| OBX-3.2 | Text | Immunization Schedule used | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 3 | |
| OBX-2 | Value Type | ID | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59781-5 | |
| OBX-3.2 | Text | dose validity | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | Y | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 4 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30956-7 | |
| OBX-3.2 | Text | vaccine type | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 2 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 5 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59779-9 | |
| OBX-3.2 | Text | Immunization Schedule used | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 2 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 6 | |
| OBX-2 | Value Type | ID | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59781-5 | |
| OBX-3.2 | Text | dose validity | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 2 | |
| OBX-5 | Observation Value | Y | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 7 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30956-7 | |
| OBX-3.2 | Text | vaccine type | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 3 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 8 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59779-9 | |
| OBX-3.2 | Text | Immunization Schedule used | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 3 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 9 | |
| OBX-2 | Value Type | ID | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59781-5 | |
| OBX-3.2 | Text | dose validity | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 3 | |
| OBX-5 | Observation Value | Y | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 1 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30956-7 | |
| OBX-3.2 | Text | vaccine type | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 2 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59779-9 | |
| OBX-3.2 | Text | Immunization Schedule used | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 3 | |
| OBX-2 | Value Type | ID | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59781-5 | |
| OBX-3.2 | Text | dose validity | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | Y | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 1 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30956-7 | |
| OBX-3.2 | Text | vaccine type | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 2 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59779-9 | |
| OBX-3.2 | Text | Immunization Schedule used | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 3 | |
| OBX-2 | Value Type | ID | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59781-5 | |
| OBX-3.2 | Text | dose validity | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | N | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 1 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30956-7 | |
| OBX-3.2 | Text | vaccine type | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 2 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59779-9 | |
| OBX-3.2 | Text | Immunization Schedule used | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 3 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30980-7 | |
| OBX-3.2 | Text | Date vaccination due | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | 20100214 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 4 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30981-5 | |
| OBX-3.2 | Text | Earliest Date to give | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | 20100214 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 5 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30956-7 | |
| OBX-3.2 | Text | vaccine type | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 2 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 6 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59779-9 | |
| OBX-3.2 | Text | Immunization Schedule used | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 2 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 7 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30980-7 | |
| OBX-3.2 | Text | Date vaccination due | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 2 | |
| OBX-5 | Observation Value | 20100214 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 8 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30956-7 | |
| OBX-3.2 | Text | vaccine type | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 3 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 9 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59779-9 | |
| OBX-3.2 | Text | Immunization Schedule used | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 3 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 10 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30980-7 | |
| OBX-3.2 | Text | Date vaccination due | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 3 | |
| OBX-5 | Observation Value | 20100214 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | |
| MSH-2 | Encoding Characters | ^~\& | |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | NIST IIS APP | |
| MSH-3.2 | Universal ID | ||
| MSH-3.3 | Universal ID Type | ||
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | NIST IIS FAC | |
| MSH-4.2 | Universal ID | ||
| MSH-4.3 | Universal ID Type | ||
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | NIST EHR APP | |
| MSH-5.2 | Universal ID | ||
| MSH-5.3 | Universal ID Type | ||
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | NIST EHR Facility | |
| MSH-6.2 | Universal ID | ||
| MSH-6.3 | Universal ID Type | ||
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20151031145233-0500 | |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | RSP | |
| MSH-9.2 | Trigger Event | K11 | |
| MSH-9.3 | Message Structure | RSP_K11 | |
| MSH-10 | Message Control ID | NIST-IZ-QR-1.2_Response_K11_Z42 | |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | |
| MSH-15 | Accept Acknowledgment Type | NE | |
| MSH-16 | Application Acknowledgment Type | NE | |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z42 | |
| MSH-21.2 | Namespace ID | CDCPHINVS | |
| MSH-21.3 | Universal ID | ||
| MSH-21.4 | Universal ID Type | ||
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | NIST IIS FAC | |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | NIST-AA-1 | |
| MSH-22.6.2 | Universal ID | ||
| MSH-22.6.3 | Universal ID Type | ||
| MSH-22.7 | Identifier Type Code | XX | |
| MSH-22.10 | Organization Identifier | 100-1776 | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | NIST EHR Facility | |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | NIST-AA-1 | |
| MSH-23.6.2 | Universal ID | ||
| MSH-23.6.3 | Universal ID Type | ||
| MSH-23.7 | Identifier Type Code | XX | |
| MSH-23.10 | Organization Identifier | 100-6482 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA-1 | Acknowledgment Code | AA | |
| MSA-2 | Message Control ID | NIST-IZ-QR-1.1_Query_Q11_Z44 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QAK-1 | Query Tag | IZ-1.1-2015 | |
| QAK-2 | Query Response Status | OK | |
| QAK-3 | Message Query Name | ||
| QAK-3.1 | Identifier | Z44 | |
| QAK-3.2 | Text | request evaluated Immunization history | |
| QAK-3.3 | Name of Coding System | CDCPHINVS | |
| QAK-3.5 | Alternate Text | ||
| QAK-3.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD-1 | Message Query Name | ||
| QPD-1.1 | Identifier | Z44 | |
| QPD-1.2 | Text | Request Evaluated History and Forecast | |
| QPD-1.3 | Name of Coding System | CDCPHINVS | |
| QPD-1.5 | Alternate Text | ||
| QPD-1.6 | Name of Alternate Coding System | ||
| QPD-2 | Query Tag | 107374859 | |
| QPD-3 | PatientList | ||
| QPD-3.1 | ID Number | 171122 | |
| QPD-3.3 | Check Digit Scheme | ||
| QPD-3.4 | Assigning Authority | ||
| QPD-3.4.1 | Namespace ID | NIST MPI | |
| QPD-3.4.2 | Universal ID | ||
| QPD-3.4.3 | Universal ID Type | ||
| QPD-3.5 | Identifier Type Code | MR | |
| QPD-4 | PatientName | ||
| QPD-4.1 | Family Name | ||
| QPD-4.1.1 | Surname | Child | |
| QPD-4.1.2 | Own Surname Prefix | ||
| QPD-4.1.3 | Own Surname | ||
| QPD-4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD-4.1.5 | Surname From Partner/Spouse | ||
| QPD-4.2 | Given Name | Bobbie | |
| QPD-4.3 | Second and Further Given Names or Initials Thereof | Q | |
| QPD-4.7 | Name Type Code | L | |
| QPD-5 | PatientMotherMaidenName | ||
| QPD-5.1 | Family Name | ||
| QPD-5.1.1 | Surname | Que | |
| QPD-5.1.2 | Own Surname Prefix | ||
| QPD-5.1.3 | Own Surname | ||
| QPD-5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD-5.1.5 | Surname From Partner/Spouse | ||
| QPD-5.7 | Name Type Code | M | |
| QPD-6 | PatientDateOfBirth | ||
| QPD-6.1 | Time | 20090214 | |
| QPD-7 | Patient Sex | M | |
| QPD-8 | Patient Address | ||
| QPD-8.1 | Street Address | ||
| QPD-8.1.1 | Street or Mailing Address | 105 Laurel Run Rd | |
| QPD-8.1.2 | Street Name | ||
| QPD-8.1.3 | Dwelling Number | ||
| QPD-8.2 | Other Designation | ||
| QPD-8.3 | City | Bozeman | |
| QPD-8.4 | State or Province | MT | |
| QPD-8.5 | Zip or Postal Code | ||
| QPD-8.6 | Country | ||
| QPD-8.7 | Address Type | L | |
| QPD-9 | Phone | ||
| QPD-9.2 | Telecommunication Use Code | ||
| QPD-9.3 | Telecommunication Equipment Type | ||
| QPD-9.4 | Email Address | ||
| QPD-9.6 | Area/City Code | ||
| QPD-9.7 | Local Number | ||
| QPD-10 | Multiple birth indicator | ||
| QPD-11 | Birth order |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID-1 | Set ID - PID | 1 | |
| PID-3[1] | Patient Identifier List | ||
| PID-3[1].1 | ID Number | 171122 | |
| PID-3[1].3 | Check Digit Scheme | ||
| PID-3[1].4 | Assigning Authority | ||
| PID-3[1].4.1 | Namespace ID | NIST MPI | |
| PID-3[1].4.2 | Universal ID | ||
| PID-3[1].4.3 | Universal ID Type | ||
| PID-3[1].5 | Identifier Type Code | MR | |
| PID-3[2] | Patient Identifier List | ||
| PID-3[2].1 | ID Number | 34500907 | |
| PID-3[2].3 | Check Digit Scheme | ||
| PID-3[2].4 | Assigning Authority | ||
| PID-3[2].4.1 | Namespace ID | MyIIS | |
| PID-3[2].4.2 | Universal ID | ||
| PID-3[2].4.3 | Universal ID Type | ||
| PID-3[2].5 | Identifier Type Code | SR | |
| PID-5 | Patient Name | ||
| PID-5.1 | Family Name | ||
| PID-5.1.1 | Surname | Child | |
| PID-5.1.2 | Own Surname Prefix | ||
| PID-5.1.3 | Own Surname | ||
| PID-5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-5.1.5 | Surname From Partner/Spouse | ||
| PID-5.2 | Given Name | Bobbie | |
| PID-5.3 | Second and Further Given Names or Initials Thereof | Q | |
| PID-5.7 | Name Type Code | L | |
| PID-7 | Date/Time of Birth | ||
| PID-7.1 | Time | 20090214 | |
| PID-8 | Administrative Sex | M | |
| PID-11 | Patient Address | ||
| PID-11.1 | Street Address | ||
| PID-11.1.1 | Street or Mailing Address | 105 Laurel Run Rd | |
| PID-11.1.2 | Street Name | ||
| PID-11.1.3 | Dwelling Number | ||
| PID-11.2 | Other Designation | ||
| PID-11.3 | City | Bozeman | |
| PID-11.4 | State or Province | MT | |
| PID-11.5 | Zip or Postal Code | ||
| PID-11.6 | Country | ||
| PID-11.7 | Address Type | L | |
| PID-30 | Patient Death Indicator |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | ||
| ORC-2.2 | Namespace ID | ||
| ORC-2.3 | Universal ID | ||
| ORC-2.4 | Universal ID Type | ||
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 197023 | |
| ORC-3.2 | Namespace ID | NIST-AA-1 | |
| ORC-3.3 | Universal ID | ||
| ORC-3.4 | Universal ID Type | ||
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | wc | |
| ORC-17.2 | Text | West Clinic | |
| ORC-17.3 | Name of Coding System | HL70362 | |
| ORC-17.5 | Alternate Text | ||
| ORC-17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | ||
| ORC-2.2 | Namespace ID | ||
| ORC-2.3 | Universal ID | ||
| ORC-2.4 | Universal ID Type | ||
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 197027 | |
| ORC-3.2 | Namespace ID | DCS | |
| ORC-3.3 | Universal ID | ||
| ORC-3.4 | Universal ID Type | ||
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | ||
| ORC-17.2 | Text | ||
| ORC-17.3 | Name of Coding System | ||
| ORC-17.5 | Alternate Text | ||
| ORC-17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | ||
| ORC-2.2 | Namespace ID | ||
| ORC-2.3 | Universal ID | ||
| ORC-2.4 | Universal ID Type | ||
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 197028 | |
| ORC-3.2 | Namespace ID | DCS | |
| ORC-3.3 | Universal ID | ||
| ORC-3.4 | Universal ID Type | ||
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | ||
| ORC-17.2 | Text | ||
| ORC-17.3 | Name of Coding System | ||
| ORC-17.5 | Alternate Text | ||
| ORC-17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | ||
| ORC-2.2 | Namespace ID | ||
| ORC-2.3 | Universal ID | ||
| ORC-2.4 | Universal ID Type | ||
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 197028 | |
| ORC-3.2 | Namespace ID | DCS | |
| ORC-3.3 | Universal ID | ||
| ORC-3.4 | Universal ID Type | ||
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | ||
| ORC-17.2 | Text | ||
| ORC-17.3 | Name of Coding System | ||
| ORC-17.5 | Alternate Text | ||
| ORC-17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | ||
| ORC-2.2 | Namespace ID | ||
| ORC-2.3 | Universal ID | ||
| ORC-2.4 | Universal ID Type | ||
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 197028 | |
| ORC-3.2 | Namespace ID | DCS | |
| ORC-3.3 | Universal ID | ||
| ORC-3.4 | Universal ID Type | ||
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | ||
| ORC-17.2 | Text | ||
| ORC-17.3 | Name of Coding System | ||
| ORC-17.5 | Alternate Text | ||
| ORC-17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | ||
| ORC-2.2 | Namespace ID | ||
| ORC-2.3 | Universal ID | ||
| ORC-2.4 | Universal ID Type | ||
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 9999 | |
| ORC-3.2 | Namespace ID | DCS | |
| ORC-3.3 | Universal ID | ||
| ORC-3.4 | Universal ID Type | ||
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | DCS | |
| ORC-17.2 | Text | Dabig Clinical System | |
| ORC-17.3 | Name of Coding System | HL70362 | |
| ORC-17.5 | Alternate Text | ||
| ORC-17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | |
| RXA-2 | Administration Sub-ID Counter | 1 | |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20090415 | |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 31 | |
| RXA-5.2 | Text | Hep B Peds NOS | |
| RXA-5.3 | Name of Coding System | CVX | |
| RXA-5.5 | Alternate Text | ||
| RXA-5.6 | Name of Alternate Coding System | ||
| RXA-6 | Administered Amount | 999 | |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | ||
| RXA-7.2 | Text | ||
| RXA-7.3 | Name of Coding System | ||
| RXA-7.5 | Alternate Text | ||
| RXA-7.6 | Name of Alternate Coding System | ||
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 01 | |
| RXA-9.2 | Text | historical record | |
| RXA-9.3 | Name of Coding System | NIP001 | |
| RXA-9.5 | Alternate Text | ||
| RXA-9.6 | Name of Alternate Coding System | ||
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | ||
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | ||
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | ||
| RXA-10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | ||
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | ||
| RXA-10.12 | Check Digit Scheme | ||
| RXA-10.13 | Identifier Type Code | ||
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | ||
| RXA-11.4.2 | Universal ID | ||
| RXA-11.4.3 | Universal ID Type | ||
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | ||
| RXA-18.2 | Text | ||
| RXA-18.3 | Name of Coding System | ||
| RXA-18.5 | Alternate Text | ||
| RXA-18.6 | Name of Alternate Coding System | ||
| RXA-20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | |
| RXA-2 | Administration Sub-ID Counter | 1 | |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20090314 | |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 48 | |
| RXA-5.2 | Text | HIB PRP-T | |
| RXA-5.3 | Name of Coding System | CVX | |
| RXA-5.5 | Alternate Text | ||
| RXA-5.6 | Name of Alternate Coding System | ||
| RXA-6 | Administered Amount | 999 | |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | ||
| RXA-7.2 | Text | ||
| RXA-7.3 | Name of Coding System | ||
| RXA-7.5 | Alternate Text | ||
| RXA-7.6 | Name of Alternate Coding System | ||
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 01 | |
| RXA-9.2 | Text | historic immunization record | |
| RXA-9.3 | Name of Coding System | NIP001 | |
| RXA-9.5 | Alternate Text | ||
| RXA-9.6 | Name of Alternate Coding System | ||
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | ||
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Sticker | |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Nurse | |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | ||
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | ||
| RXA-10.12 | Check Digit Scheme | ||
| RXA-10.13 | Identifier Type Code | ||
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | DCS_DC | |
| RXA-11.4.2 | Universal ID | ||
| RXA-11.4.3 | Universal ID Type | ||
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | ||
| RXA-18.2 | Text | ||
| RXA-18.3 | Name of Coding System | ||
| RXA-18.5 | Alternate Text | ||
| RXA-18.6 | Name of Alternate Coding System | ||
| RXA-20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | |
| RXA-2 | Administration Sub-ID Counter | 1 | |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20091011 | |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 110 | |
| RXA-5.2 | Text | DTAP-Hep B-IPV | |
| RXA-5.3 | Name of Coding System | CVX | |
| RXA-5.5 | Alternate Text | ||
| RXA-5.6 | Name of Alternate Coding System | ||
| RXA-6 | Administered Amount | 999 | |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | ||
| RXA-7.2 | Text | ||
| RXA-7.3 | Name of Coding System | ||
| RXA-7.5 | Alternate Text | ||
| RXA-7.6 | Name of Alternate Coding System | ||
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 01 | |
| RXA-9.2 | Text | historic immunization record | |
| RXA-9.3 | Name of Coding System | NIP001 | |
| RXA-9.5 | Alternate Text | ||
| RXA-9.6 | Name of Alternate Coding System | ||
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | ||
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | ||
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | ||
| RXA-10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | ||
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | ||
| RXA-10.12 | Check Digit Scheme | ||
| RXA-10.13 | Identifier Type Code | ||
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | ||
| RXA-11.4.2 | Universal ID | ||
| RXA-11.4.3 | Universal ID Type | ||
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | ||
| RXA-18.2 | Text | ||
| RXA-18.3 | Name of Coding System | ||
| RXA-18.5 | Alternate Text | ||
| RXA-18.6 | Name of Alternate Coding System | ||
| RXA-20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | |
| RXA-2 | Administration Sub-ID Counter | 1 | |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20100411 | |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 08 | |
| RXA-5.2 | Text | Hep BPEDS | |
| RXA-5.3 | Name of Coding System | CVX | |
| RXA-5.5 | Alternate Text | ||
| RXA-5.6 | Name of Alternate Coding System | ||
| RXA-6 | Administered Amount | 999 | |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | ||
| RXA-7.2 | Text | ||
| RXA-7.3 | Name of Coding System | ||
| RXA-7.5 | Alternate Text | ||
| RXA-7.6 | Name of Alternate Coding System | ||
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 01 | |
| RXA-9.2 | Text | historic immunization record | |
| RXA-9.3 | Name of Coding System | NIP001 | |
| RXA-9.5 | Alternate Text | ||
| RXA-9.6 | Name of Alternate Coding System | ||
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | ||
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Sticker | |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Nurse | |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | ||
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | ||
| RXA-10.12 | Check Digit Scheme | ||
| RXA-10.13 | Identifier Type Code | ||
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | ||
| RXA-11.4.2 | Universal ID | ||
| RXA-11.4.3 | Universal ID Type | ||
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | ||
| RXA-18.2 | Text | ||
| RXA-18.3 | Name of Coding System | ||
| RXA-18.5 | Alternate Text | ||
| RXA-18.6 | Name of Alternate Coding System | ||
| RXA-20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | |
| RXA-2 | Administration Sub-ID Counter | 1 | |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20100415 | |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 03 | |
| RXA-5.2 | Text | MMR | |
| RXA-5.3 | Name of Coding System | CVX | |
| RXA-5.5 | Alternate Text | ||
| RXA-5.6 | Name of Alternate Coding System | ||
| RXA-6 | Administered Amount | 999 | |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | ||
| RXA-7.2 | Text | ||
| RXA-7.3 | Name of Coding System | ||
| RXA-7.5 | Alternate Text | ||
| RXA-7.6 | Name of Alternate Coding System | ||
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 01 | |
| RXA-9.2 | Text | historic immunization record | |
| RXA-9.3 | Name of Coding System | NIP001 | |
| RXA-9.5 | Alternate Text | ||
| RXA-9.6 | Name of Alternate Coding System | ||
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | ||
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | ||
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | ||
| RXA-10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | ||
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | ||
| RXA-10.12 | Check Digit Scheme | ||
| RXA-10.13 | Identifier Type Code | ||
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | ||
| RXA-11.4.2 | Universal ID | ||
| RXA-11.4.3 | Universal ID Type | ||
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | ||
| RXA-18.2 | Text | ||
| RXA-18.3 | Name of Coding System | ||
| RXA-18.5 | Alternate Text | ||
| RXA-18.6 | Name of Alternate Coding System | ||
| RXA-20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | |
| RXA-2 | Administration Sub-ID Counter | 1 | |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20091031 | |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 998 | |
| RXA-5.2 | Text | no vaccine admin | |
| RXA-5.3 | Name of Coding System | CVX | |
| RXA-5.5 | Alternate Text | ||
| RXA-5.6 | Name of Alternate Coding System | ||
| RXA-6 | Administered Amount | 999 | |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | ||
| RXA-7.2 | Text | ||
| RXA-7.3 | Name of Coding System | ||
| RXA-7.5 | Alternate Text | ||
| RXA-7.6 | Name of Alternate Coding System | ||
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | ||
| RXA-9.2 | Text | ||
| RXA-9.3 | Name of Coding System | ||
| RXA-9.5 | Alternate Text | ||
| RXA-9.6 | Name of Alternate Coding System | ||
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | ||
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | ||
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | ||
| RXA-10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | ||
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | ||
| RXA-10.12 | Check Digit Scheme | ||
| RXA-10.13 | Identifier Type Code | ||
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | ||
| RXA-11.4.2 | Universal ID | ||
| RXA-11.4.3 | Universal ID Type | ||
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | ||
| RXA-18.2 | Text | ||
| RXA-18.3 | Name of Coding System | ||
| RXA-18.5 | Alternate Text | ||
| RXA-18.6 | Name of Alternate Coding System | ||
| RXA-20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 1 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30956-7 | |
| OBX-3.2 | Text | vaccine type | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 2 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59779-9 | |
| OBX-3.2 | Text | Immunization Schedule used | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 3 | |
| OBX-2 | Value Type | ID | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59781-5 | |
| OBX-3.2 | Text | dose validity | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | Y | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 1 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30956-7 | |
| OBX-3.2 | Text | vaccine type | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 2 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59779-9 | |
| OBX-3.2 | Text | Immunization Schedule used | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 3 | |
| OBX-2 | Value Type | ID | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59781-5 | |
| OBX-3.2 | Text | dose validity | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | N | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 4 | |
| OBX-2 | Value Type | ST | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30982-3 | |
| OBX-3.2 | Text | Reason applied | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | Too Young | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 1 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30956-7 | |
| OBX-3.2 | Text | vaccine type | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 2 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59779-9 | |
| OBX-3.2 | Text | Immunization Schedule used | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 3 | |
| OBX-2 | Value Type | ID | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59781-5 | |
| OBX-3.2 | Text | dose validity | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | Y | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 4 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30956-7 | |
| OBX-3.2 | Text | vaccine type | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 2 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 5 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59779-9 | |
| OBX-3.2 | Text | Immunization Schedule used | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 2 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 6 | |
| OBX-2 | Value Type | ID | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59781-5 | |
| OBX-3.2 | Text | dose validity | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 2 | |
| OBX-5 | Observation Value | Y | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 7 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30956-7 | |
| OBX-3.2 | Text | vaccine type | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 3 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 8 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59779-9 | |
| OBX-3.2 | Text | Immunization Schedule used | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 3 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 9 | |
| OBX-2 | Value Type | ID | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59781-5 | |
| OBX-3.2 | Text | dose validity | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 3 | |
| OBX-5 | Observation Value | Y | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 1 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30956-7 | |
| OBX-3.2 | Text | vaccine type | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 2 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59779-9 | |
| OBX-3.2 | Text | Immunization Schedule used | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 3 | |
| OBX-2 | Value Type | ID | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59781-5 | |
| OBX-3.2 | Text | dose validity | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | Y | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 1 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30956-7 | |
| OBX-3.2 | Text | vaccine type | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 2 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59779-9 | |
| OBX-3.2 | Text | Immunization Schedule used | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 3 | |
| OBX-2 | Value Type | ID | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59781-5 | |
| OBX-3.2 | Text | dose validity | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | N | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 1 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30956-7 | |
| OBX-3.2 | Text | vaccine type | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 2 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59779-9 | |
| OBX-3.2 | Text | Immunization Schedule used | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 3 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30980-7 | |
| OBX-3.2 | Text | Date vaccination due | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | 20100214 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 4 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30981-5 | |
| OBX-3.2 | Text | Earliest Date to give | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | 20100214 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 5 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30956-7 | |
| OBX-3.2 | Text | vaccine type | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 2 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 6 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59779-9 | |
| OBX-3.2 | Text | Immunization Schedule used | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 2 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 7 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30980-7 | |
| OBX-3.2 | Text | Date vaccination due | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 2 | |
| OBX-5 | Observation Value | 20100214 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 8 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30956-7 | |
| OBX-3.2 | Text | vaccine type | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 3 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 9 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59779-9 | |
| OBX-3.2 | Text | Immunization Schedule used | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 3 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 10 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30980-7 | |
| OBX-3.2 | Text | Date vaccination due | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 3 | |
| OBX-5 | Observation Value | 20100214 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151031 |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Evaluated Immunization History and Immunization Forecast | |||||
|---|---|---|---|---|---|
| Test Case ID | IZ-QR-1_Query_Child | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement (Pass/Fail) |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.
The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.
The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.
| Patient Information | ||||
|---|---|---|---|---|
| Patient Identifier | Patient Name | DOB | Gender | Tester Comment |
| 171122 | Bobbie Q Child | 02/14/2009 | Male | |
| When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient. | ||||
| Evaluated Immunization History and Immunization Forecast |
|---|
| Immunization Schedule Used | Tester Comment |
|---|---|
| ACIP |
| Evaluated Immunization History | ||||||
|---|---|---|---|---|---|---|
| Vaccine Group | Vaccine Administered | Date Administered | Valid Dose | Validity Reason | Completion Status* | Tester Comment |
| Hep B NOS | Hep B Peds NOS | 04/15/2009 | YES | Complete | ||
| HIB NOS | HIB PRP-T | 03/14/2009 | NO | Too Young | Complete | |
| Hep B NOS | DTAP-Hep B-IPV | 10/11/2009 | YES | Complete | ||
| IPV | DTAP-Hep B-IPV | 10/11/2009 | YES | Complete | ||
| DTAP | DTAP-Hep B-IPV | 10/11/2009 | YES | Complete | ||
| Hep B NOS | Hep BPEDS | 04/11/2010 | YES | Complete | ||
| MMR | MMR | 04/15/2010 | NO | Complete | ||
| * "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered". | ||||||
| Immunization Forecast | ||||
|---|---|---|---|---|
| Vaccine Group | Due Date | Earliest Date To Give | Latest Date to Give | Tester Comment |
| MMR | 02/14/2010 | 02/14/2010 | ||
| IPV | 02/14/2010 | |||
| DTAP | 02/14/2010 | |||
| Description |
|---|
| Query for an adult using the most significant query parameters. The patient is found in the IIS. A response message is returned with a single immunization event and multiple immunization recommendations. An adult male patient, Stanley S. Clement presents to the clinic, seeking an immunization for influenza. A clinic staff member locates his medical record in the electronic health record system. The staff member sees that he has previously had an immunization against influenza. The staff member triggers a request to the IIS to request an evaluated history and forecast for the patient. The IIS performs a search for Stanley S. Clement and finds one high confidence match. The IIS generates an evaluated history and forecast for Mr. Clement and returns this to the EHR-S. The EHR-S displays the evaluated history and forecast to the staff member. |
| Comments |
|---|
| No Comments |
| Pre Condition |
|---|
| Person exists in the system with the complete demographics as provided in the Test Data Specification. Person has Medical Record Number (MR). Person does not have existing immunization events in their EHR. Person does have an immunization history in the IIS, |
| Post Condition |
|---|
| The clinician is able to view the evaluated history and forecast from the IIS. There is no obligation to incorporate the data into the EHR-S or maintain the displayed evaluated history and forecast. |
| Test Objectives |
|---|
| Evaluates EHR-S ability to create a well formed query for an adult. Evaluates EHR-S ability to accept a response with evaluated history and forecast for that person. |
| Evaluation Criteria |
|---|
|
| Notes for Testers |
|---|
| The NIST tool is simulating a response from the IIS. |
| Description |
|---|
| An adult male patient, Stanley S. Clement presents to the clinic, seeking an immunization for influenza. A clinic staff member locates his medical record in the electronic health record system. The staff member sees that he has previously had an immunization against influenza. The staff member triggers a request to the IIS to request an evaluated history and forecast for the patient. |
| Comments |
|---|
| Most of the test data is categorized as Test Case Fixed. It is important that the data is entered into the querying system as specified to enable linking the response message to the patient record. |
| Pre Condition |
|---|
| Person exists in the querying system with the complete demographics as provided in the Test Data Specification. Person has Medical Record Number (MR). Person does not have existing immunization events in their EHR. Person does have an immunization history in the IIS (simulated by the NIST Test Tool). |
| Post Condition |
|---|
| IIS returns a response message for the person containing a single immunization event and multiple recommendations. |
| Test Objectives |
|---|
| Test the ability of the system to successfully create a query message based on the given test data. |
| Evaluation Criteria |
|---|
| Tester inspects patient record; confirms that the patients does not have existing immunization events. Confirms valid query message using Message Validation Report. |
| Notes for Testers |
|---|
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | NIST EHR APP | Presence-Configuration |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | NIST EHR Facility | Presence-Configuration |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | NIST IIS APP | Presence-Configuration |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | NIST IIS FAC | Presence-Configuration |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20141031145233-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | QBP | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | Q11 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | QBP_Q11 | Value-Profile Fixed |
| MSH-10 | Message Control ID | NIST-IZ-QR-2.1_Query_Q11_Z44 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | ER | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | AL | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z44 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Profile Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | NIST EHR Facility | Presence-Configuration |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | NIST-AA-1 | Indifferent |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | XX | Indifferent |
| MSH-22.10 | Organization Identifier | 100-6482 | Indifferent |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | NIST IIS FAC | Presence-Configuration |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | NIST-AA-1 | Indifferent |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | XX | Indifferent |
| MSH-23.10 | Organization Identifier | 100-1776 | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD-1 | Message Query Name | ||
| QPD-1.1 | Identifier | Z44 | Value-Test Case Fixed |
| QPD-1.2 | Text | Request Evaluated History and Forecast | Value-Test Case Fixed |
| QPD-1.3 | Name of Coding System | CDCPHINVS | Value-Profile Fixed |
| QPD-1.5 | Alternate Text | ||
| QPD-1.6 | Name of Alternate Coding System | ||
| QPD-2 | Query Tag | IZ-2.1-2015 | Presence-System Generated |
| QPD-3 | PatientList | ||
| QPD-3.1 | ID Number | 648286 | Value-Test Case Fixed |
| QPD-3.3 | Check Digit Scheme | ||
| QPD-3.4 | Assigning Authority | ||
| QPD-3.4.1 | Namespace ID | NIST MPI | Value-Test Case Fixed |
| QPD-3.4.2 | Universal ID | Indifferent | |
| QPD-3.4.3 | Universal ID Type | Indifferent | |
| QPD-3.5 | Identifier Type Code | MR | Value-Test Case Fixed |
| QPD-4 | PatientName | ||
| QPD-4.1 | Family Name | ||
| QPD-4.1.1 | Surname | Stanley | Value-Test Case Fixed |
| QPD-4.1.2 | Own Surname Prefix | ||
| QPD-4.1.3 | Own Surname | ||
| QPD-4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD-4.1.5 | Surname From Partner/Spouse | ||
| QPD-4.2 | Given Name | Clement | Value-Test Case Fixed |
| QPD-4.3 | Second and Further Given Names or Initials Thereof | S | Value-Test Case Fixed |
| QPD-4.7 | Name Type Code | L | Value-Test Case Fixed |
| QPD-5 | PatientMotherMaidenName | ||
| QPD-5.1 | Family Name | ||
| QPD-5.1.1 | Surname | Smith | Value-Test Case Fixed |
| QPD-5.1.2 | Own Surname Prefix | ||
| QPD-5.1.3 | Own Surname | ||
| QPD-5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD-5.1.5 | Surname From Partner/Spouse | ||
| QPD-5.7 | Name Type Code | M | Value-Profile Fixed |
| QPD-6 | PatientDateOfBirth | ||
| QPD-6.1 | Time | 19500214 | Value-Test Case Fixed |
| QPD-7 | Patient Sex | M | Value-Test Case Fixed |
| QPD-8 | Patient Address | ||
| QPD-8.1 | Street Address | ||
| QPD-8.1.1 | Street or Mailing Address | 1642 Bear Run | Value-Test Case Fixed |
| QPD-8.1.2 | Street Name | ||
| QPD-8.1.3 | Dwelling Number | ||
| QPD-8.2 | Other Designation | Indifferent | |
| QPD-8.3 | City | Boseman | Value-Test Case Fixed |
| QPD-8.4 | State or Province | MT | Value-Test Case Fixed |
| QPD-8.5 | Zip or Postal Code | 59715 | Value-Test Case Fixed |
| QPD-8.6 | Country | USA | Value-Test Case Fixed |
| QPD-8.7 | Address Type | L | Presence-Content Indifferent |
| QPD-9 | Phone | ||
| QPD-9.2 | Telecommunication Use Code | PRN | Value-Test Case Fixed |
| QPD-9.3 | Telecommunication Equipment Type | PH | Value-Test Case Fixed |
| QPD-9.4 | Email Address | ||
| QPD-9.6 | Area/City Code | 406 | Value-Test Case Fixed |
| QPD-9.7 | Local Number | 5552020 | Value-Test Case Fixed |
| QPD-10 | Multiple birth indicator | Value-Test Case Fixed | |
| QPD-11 | Birth order | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RCP-1 | Query Priority | I | Value-Profile Fixed |
| RCP-2 | Quantity Limited Request | ||
| RCP-2.1 | Quantity | 1 | Value-Test Case Fixed |
| RCP-2.2 | Units | ||
| RCP-2.2.1 | Identifier | RD | Value-Profile Fixed |
| RCP-2.2.2 | Text | Records | Value-Profile Fixed |
| RCP-2.2.3 | Name of Coding System | HL70126 | Value-Profile Fixed |
| RCP-2.2.4 | Alternate Identifier | ||
| RCP-2.2.5 | Alternate Text | ||
| RCP-2.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | NIST EHR APP | Presence-Configuration |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | NIST EHR Facility | Presence-Configuration |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | NIST IIS APP | Presence-Configuration |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | NIST IIS FAC | Presence-Configuration |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20141031145233-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | QBP | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | Q11 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | QBP_Q11 | Value-Profile Fixed |
| MSH-10 | Message Control ID | NIST-IZ-QR-2.1_Query_Q11_Z44 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | ER | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | AL | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z44 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Profile Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | NIST EHR Facility | Presence-Configuration |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | NIST-AA-1 | Indifferent |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | XX | Indifferent |
| MSH-22.10 | Organization Identifier | 100-6482 | Indifferent |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | NIST IIS FAC | Presence-Configuration |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | NIST-AA-1 | Indifferent |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | XX | Indifferent |
| MSH-23.10 | Organization Identifier | 100-1776 | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD-1 | Message Query Name | ||
| QPD-1.1 | Identifier | Z44 | Value-Test Case Fixed |
| QPD-1.2 | Text | Request Evaluated History and Forecast | Value-Test Case Fixed |
| QPD-1.3 | Name of Coding System | CDCPHINVS | Value-Profile Fixed |
| QPD-1.5 | Alternate Text | ||
| QPD-1.6 | Name of Alternate Coding System | ||
| QPD-2 | Query Tag | IZ-2.1-2015 | Presence-System Generated |
| QPD-3 | PatientList | ||
| QPD-3.1 | ID Number | 648286 | Value-Test Case Fixed |
| QPD-3.3 | Check Digit Scheme | ||
| QPD-3.4 | Assigning Authority | ||
| QPD-3.4.1 | Namespace ID | NIST MPI | Value-Test Case Fixed |
| QPD-3.4.2 | Universal ID | Indifferent | |
| QPD-3.4.3 | Universal ID Type | Indifferent | |
| QPD-3.5 | Identifier Type Code | MR | Value-Test Case Fixed |
| QPD-4 | PatientName | ||
| QPD-4.1 | Family Name | ||
| QPD-4.1.1 | Surname | Stanley | Value-Test Case Fixed |
| QPD-4.1.2 | Own Surname Prefix | ||
| QPD-4.1.3 | Own Surname | ||
| QPD-4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD-4.1.5 | Surname From Partner/Spouse | ||
| QPD-4.2 | Given Name | Clement | Value-Test Case Fixed |
| QPD-4.3 | Second and Further Given Names or Initials Thereof | S | Value-Test Case Fixed |
| QPD-4.7 | Name Type Code | L | Value-Test Case Fixed |
| QPD-5 | PatientMotherMaidenName | ||
| QPD-5.1 | Family Name | ||
| QPD-5.1.1 | Surname | Smith | Value-Test Case Fixed |
| QPD-5.1.2 | Own Surname Prefix | ||
| QPD-5.1.3 | Own Surname | ||
| QPD-5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD-5.1.5 | Surname From Partner/Spouse | ||
| QPD-5.7 | Name Type Code | M | Value-Profile Fixed |
| QPD-6 | PatientDateOfBirth | ||
| QPD-6.1 | Time | 19500214 | Value-Test Case Fixed |
| QPD-7 | Patient Sex | M | Value-Test Case Fixed |
| QPD-8 | Patient Address | ||
| QPD-8.1 | Street Address | ||
| QPD-8.1.1 | Street or Mailing Address | 1642 Bear Run | Value-Test Case Fixed |
| QPD-8.1.2 | Street Name | ||
| QPD-8.1.3 | Dwelling Number | ||
| QPD-8.2 | Other Designation | Indifferent | |
| QPD-8.3 | City | Boseman | Value-Test Case Fixed |
| QPD-8.4 | State or Province | MT | Value-Test Case Fixed |
| QPD-8.5 | Zip or Postal Code | 59715 | Value-Test Case Fixed |
| QPD-8.6 | Country | USA | Value-Test Case Fixed |
| QPD-8.7 | Address Type | L | Presence-Content Indifferent |
| QPD-9 | Phone | ||
| QPD-9.2 | Telecommunication Use Code | PRN | Value-Test Case Fixed |
| QPD-9.3 | Telecommunication Equipment Type | PH | Value-Test Case Fixed |
| QPD-9.4 | Email Address | ||
| QPD-9.6 | Area/City Code | 406 | Value-Test Case Fixed |
| QPD-9.7 | Local Number | 5552020 | Value-Test Case Fixed |
| QPD-10 | Multiple birth indicator | Value-Test Case Fixed | |
| QPD-11 | Birth order | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RCP-1 | Query Priority | I | Value-Profile Fixed |
| RCP-2 | Quantity Limited Request | ||
| RCP-2.1 | Quantity | 1 | Value-Test Case Fixed |
| RCP-2.2 | Units | ||
| RCP-2.2.1 | Identifier | RD | Value-Profile Fixed |
| RCP-2.2.2 | Text | Records | Value-Profile Fixed |
| RCP-2.2.3 | Name of Coding System | HL70126 | Value-Profile Fixed |
| RCP-2.2.4 | Alternate Identifier | ||
| RCP-2.2.5 | Alternate Text | ||
| RCP-2.2.6 | Name of Alternate Coding System |
| Element | Data |
|---|---|
| Patient Name | Clement S Stanley |
| Mother's Maiden Name | Smith |
| ID Number | 648286 |
| Date/Time of Birth | 02/14/1950 |
| Sex | Male |
| Patient Address | 1642 Bear Run Boseman MT 59715 USA |
| Patient Phone | (406)555-2020 |
| Birth Indicator | |
| Birth Order |
| Element | Data |
|---|---|
| Patient Name | Clement S Stanley |
| Mother's Maiden Name | Smith |
| ID Number | 648286 |
| Date/Time of Birth | 02/14/1950 |
| Sex | Male |
| Patient Address | 1642 Bear Run Boseman MT 59715 USA |
| Patient Phone | (406)555-2020 |
| Birth Indicator | |
| Birth Order |
| Description |
|---|
| The IIS performs a search for Stanley S. Clement and finds one high confidence match. The IIS generates an evaluated history and forecast for Mr. Clement and returns this to the EHR-S. The EHR-S displays the evaluated history and forecast to the staff member. |
| Comments |
|---|
| No Comments |
| Pre Condition |
|---|
| A query is performed by the sending system. The IIS (simulated by the NIST test tool) contains an immunization events for the person. |
| Post Condition |
|---|
| The response is made available to the EHR-S for processing. The clinician is able to view the evaluated history and forecast from the IIS (even if temporal). |
| Test Objectives |
|---|
| Demonstrate the capability to receive a response message containing the evaluated history and forecast; display evaluated history and forecast. |
| Evaluation Criteria |
|---|
| Confirms valid receipt and display of response message using the Juror Document. |
| Notes for Testers |
|---|
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | |
| MSH-2 | Encoding Characters | ^~\& | |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | NIST IIS APP | |
| MSH-3.2 | Universal ID | ||
| MSH-3.3 | Universal ID Type | ||
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | NIST IIS FAC | |
| MSH-4.2 | Universal ID | ||
| MSH-4.3 | Universal ID Type | ||
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | NIST EHR APP | |
| MSH-5.2 | Universal ID | ||
| MSH-5.3 | Universal ID Type | ||
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | NIST EHR Facility | |
| MSH-6.2 | Universal ID | ||
| MSH-6.3 | Universal ID Type | ||
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20141031145233-0500 | |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | RSP | |
| MSH-9.2 | Trigger Event | K11 | |
| MSH-9.3 | Message Structure | RSP_K11 | |
| MSH-10 | Message Control ID | NIST-IZ-QR-2.2_Response_K11_Z42 | |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | |
| MSH-15 | Accept Acknowledgment Type | NE | |
| MSH-16 | Application Acknowledgment Type | NE | |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z42 | |
| MSH-21.2 | Namespace ID | CDCPHINVS | |
| MSH-21.3 | Universal ID | ||
| MSH-21.4 | Universal ID Type | ||
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | NIST IIS FAC | |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | NIST-AA-1 | |
| MSH-22.6.2 | Universal ID | ||
| MSH-22.6.3 | Universal ID Type | ||
| MSH-22.7 | Identifier Type Code | XX | |
| MSH-22.10 | Organization Identifier | 100-1776 | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | NIST EHR Facility | |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | NIST-AA-1 | |
| MSH-23.6.2 | Universal ID | ||
| MSH-23.6.3 | Universal ID Type | ||
| MSH-23.7 | Identifier Type Code | XX | |
| MSH-23.10 | Organization Identifier | 100-6482 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA-1 | Acknowledgment Code | AA | |
| MSA-2 | Message Control ID | NIST-IZ-QR-2.1_Query_Q11_Z44 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QAK-1 | Query Tag | IZ-2.1-2015 | |
| QAK-2 | Query Response Status | OK | |
| QAK-3 | Message Query Name | ||
| QAK-3.1 | Identifier | Z44 | |
| QAK-3.2 | Text | request evaluated Immunization history | |
| QAK-3.3 | Name of Coding System | CDCPHINVS | |
| QAK-3.5 | Alternate Text | ||
| QAK-3.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD-1 | Message Query Name | ||
| QPD-1.1 | Identifier | Z44 | |
| QPD-1.2 | Text | Request Evaluated History and Forecast | |
| QPD-1.3 | Name of Coding System | CDCPHINVS | |
| QPD-1.5 | Alternate Text | ||
| QPD-1.6 | Name of Alternate Coding System | ||
| QPD-2 | Query Tag | IZ-2.1-2015 | |
| QPD-3 | PatientList | ||
| QPD-3.1 | ID Number | 648286 | |
| QPD-3.3 | Check Digit Scheme | ||
| QPD-3.4 | Assigning Authority | ||
| QPD-3.4.1 | Namespace ID | NIST MPI | |
| QPD-3.4.2 | Universal ID | ||
| QPD-3.4.3 | Universal ID Type | ||
| QPD-3.5 | Identifier Type Code | MR | |
| QPD-4 | PatientName | ||
| QPD-4.1 | Family Name | ||
| QPD-4.1.1 | Surname | Stanley | |
| QPD-4.1.2 | Own Surname Prefix | ||
| QPD-4.1.3 | Own Surname | ||
| QPD-4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD-4.1.5 | Surname From Partner/Spouse | ||
| QPD-4.2 | Given Name | Clement | |
| QPD-4.3 | Second and Further Given Names or Initials Thereof | S | |
| QPD-4.7 | Name Type Code | L | |
| QPD-5 | PatientMotherMaidenName | ||
| QPD-5.1 | Family Name | ||
| QPD-5.1.1 | Surname | Smith | |
| QPD-5.1.2 | Own Surname Prefix | ||
| QPD-5.1.3 | Own Surname | ||
| QPD-5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD-5.1.5 | Surname From Partner/Spouse | ||
| QPD-5.7 | Name Type Code | M | |
| QPD-6 | PatientDateOfBirth | ||
| QPD-6.1 | Time | 19500214 | |
| QPD-7 | Patient Sex | M | |
| QPD-8 | Patient Address | ||
| QPD-8.1 | Street Address | ||
| QPD-8.1.1 | Street or Mailing Address | 1642 Bear Run | |
| QPD-8.1.2 | Street Name | ||
| QPD-8.1.3 | Dwelling Number | ||
| QPD-8.2 | Other Designation | ||
| QPD-8.3 | City | Boseman | |
| QPD-8.4 | State or Province | MT | |
| QPD-8.5 | Zip or Postal Code | 59715 | |
| QPD-8.6 | Country | USA | |
| QPD-8.7 | Address Type | L | |
| QPD-9 | Phone | ||
| QPD-9.2 | Telecommunication Use Code | PRN | |
| QPD-9.3 | Telecommunication Equipment Type | PH | |
| QPD-9.4 | Email Address | ||
| QPD-9.6 | Area/City Code | 406 | |
| QPD-9.7 | Local Number | 5552020 | |
| QPD-10 | Multiple birth indicator | ||
| QPD-11 | Birth order |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID-1 | Set ID - PID | 1 | |
| PID-3[1] | Patient Identifier List | ||
| PID-3[1].1 | ID Number | 648286 | |
| PID-3[1].3 | Check Digit Scheme | ||
| PID-3[1].4 | Assigning Authority | ||
| PID-3[1].4.1 | Namespace ID | NIST MPI | |
| PID-3[1].4.2 | Universal ID | ||
| PID-3[1].4.3 | Universal ID Type | ||
| PID-3[1].5 | Identifier Type Code | MR | |
| PID-3[2] | Patient Identifier List | ||
| PID-3[2].1 | ID Number | 34500907 | |
| PID-3[2].3 | Check Digit Scheme | ||
| PID-3[2].4 | Assigning Authority | ||
| PID-3[2].4.1 | Namespace ID | IIS-AA | |
| PID-3[2].4.2 | Universal ID | ||
| PID-3[2].4.3 | Universal ID Type | ||
| PID-3[2].5 | Identifier Type Code | SR | |
| PID-5 | Patient Name | ||
| PID-5.1 | Family Name | ||
| PID-5.1.1 | Surname | Stanley | |
| PID-5.1.2 | Own Surname Prefix | ||
| PID-5.1.3 | Own Surname | ||
| PID-5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-5.1.5 | Surname From Partner/Spouse | ||
| PID-5.2 | Given Name | Clement | |
| PID-5.3 | Second and Further Given Names or Initials Thereof | S | |
| PID-5.7 | Name Type Code | L | |
| PID-7 | Date/Time of Birth | ||
| PID-7.1 | Time | 19950101 | |
| PID-8 | Administrative Sex | M | |
| PID-11 | Patient Address | ||
| PID-11.1 | Street Address | ||
| PID-11.1.1 | Street or Mailing Address | 1642 Bear Run | |
| PID-11.1.2 | Street Name | ||
| PID-11.1.3 | Dwelling Number | ||
| PID-11.2 | Other Designation | ||
| PID-11.3 | City | Bozeman | |
| PID-11.4 | State or Province | MT | |
| PID-11.5 | Zip or Postal Code | 59715 | |
| PID-11.6 | Country | USA | |
| PID-11.7 | Address Type | L | |
| PID-30 | Patient Death Indicator |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | ||
| ORC-2.2 | Namespace ID | ||
| ORC-2.3 | Universal ID | ||
| ORC-2.4 | Universal ID Type | ||
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 193337027 | |
| ORC-3.2 | Namespace ID | IIS-AA | |
| ORC-3.3 | Universal ID | ||
| ORC-3.4 | Universal ID Type | ||
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | ||
| ORC-17.2 | Text | ||
| ORC-17.3 | Name of Coding System | ||
| ORC-17.5 | Alternate Text | ||
| ORC-17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | ||
| ORC-2.2 | Namespace ID | ||
| ORC-2.3 | Universal ID | ||
| ORC-2.4 | Universal ID Type | ||
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 9999 | |
| ORC-3.2 | Namespace ID | DCS | |
| ORC-3.3 | Universal ID | ||
| ORC-3.4 | Universal ID Type | ||
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | DCS | |
| ORC-17.2 | Text | Dabig Clinical System | |
| ORC-17.3 | Name of Coding System | HL70362 | |
| ORC-17.5 | Alternate Text | ||
| ORC-17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | |
| RXA-2 | Administration Sub-ID Counter | 1 | |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20151029 | |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 140 | |
| RXA-5.2 | Text | seasonal flu | |
| RXA-5.3 | Name of Coding System | CVX | |
| RXA-5.5 | Alternate Text | ||
| RXA-5.6 | Name of Alternate Coding System | ||
| RXA-6 | Administered Amount | 0.5 | |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | mL | |
| RXA-7.2 | Text | ||
| RXA-7.3 | Name of Coding System | UCUM | |
| RXA-7.5 | Alternate Text | ||
| RXA-7.6 | Name of Alternate Coding System | ||
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 00 | |
| RXA-9.2 | Text | new immunization record | |
| RXA-9.3 | Name of Coding System | NIP001 | |
| RXA-9.5 | Alternate Text | ||
| RXA-9.6 | Name of Alternate Coding System | ||
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | ||
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Sticker | |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Nurse | |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | ||
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | ||
| RXA-10.12 | Check Digit Scheme | ||
| RXA-10.13 | Identifier Type Code | ||
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | DCS_DC | |
| RXA-11.4.2 | Universal ID | ||
| RXA-11.4.3 | Universal ID Type | ||
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | ||
| RXA-18.2 | Text | ||
| RXA-18.3 | Name of Coding System | ||
| RXA-18.5 | Alternate Text | ||
| RXA-18.6 | Name of Alternate Coding System | ||
| RXA-20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | |
| RXA-2 | Administration Sub-ID Counter | 1 | |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20151029 | |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 998 | |
| RXA-5.2 | Text | no vaccine admin | |
| RXA-5.3 | Name of Coding System | CVX | |
| RXA-5.5 | Alternate Text | ||
| RXA-5.6 | Name of Alternate Coding System | ||
| RXA-6 | Administered Amount | 999 | |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | ||
| RXA-7.2 | Text | ||
| RXA-7.3 | Name of Coding System | ||
| RXA-7.5 | Alternate Text | ||
| RXA-7.6 | Name of Alternate Coding System | ||
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | ||
| RXA-9.2 | Text | ||
| RXA-9.3 | Name of Coding System | ||
| RXA-9.5 | Alternate Text | ||
| RXA-9.6 | Name of Alternate Coding System | ||
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | ||
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | ||
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | ||
| RXA-10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | ||
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | ||
| RXA-10.12 | Check Digit Scheme | ||
| RXA-10.13 | Identifier Type Code | ||
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | ||
| RXA-11.4.2 | Universal ID | ||
| RXA-11.4.3 | Universal ID Type | ||
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | ||
| RXA-18.2 | Text | ||
| RXA-18.3 | Name of Coding System | ||
| RXA-18.5 | Alternate Text | ||
| RXA-18.6 | Name of Alternate Coding System | ||
| RXA-20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR-1 | Route | ||
| RXR-1.1 | Identifier | C28161 | |
| RXR-1.2 | Text | IM | |
| RXR-1.3 | Name of Coding System | NCIT | |
| RXR-1.5 | Alternate Text | ||
| RXR-1.6 | Name of Alternate Coding System | ||
| RXR-2 | Administration Site | ||
| RXR-2.1 | Identifier | ||
| RXR-2.2 | Text | ||
| RXR-2.3 | Name of Coding System | ||
| RXR-2.5 | Alternate Text | ||
| RXR-2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 1 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30956-7 | |
| OBX-3.2 | Text | vaccine type | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 2 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59779-9 | |
| OBX-3.2 | Text | Immunization Schedule used | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151029 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 3 | |
| OBX-2 | Value Type | ID | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59781-5 | |
| OBX-3.2 | Text | dose validity | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | Y | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151029 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 4 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30956-7 | |
| OBX-3.2 | Text | vaccine type | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 5 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59779-9 | |
| OBX-3.2 | Text | Immunization Schedule used | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 6 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30980-7 | |
| OBX-3.2 | Text | Date vaccination due | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | 20600101 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 7 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30981-5 | |
| OBX-3.2 | Text | Earliest Date to give | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | 20600101 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 8 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30956-7 | |
| OBX-3.2 | Text | vaccine type | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 2 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 9 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59779-9 | |
| OBX-3.2 | Text | Immunization Schedule used | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 2 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 10 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30980-7 | |
| OBX-3.2 | Text | Date vaccination due | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 2 | |
| OBX-5 | Observation Value | 20160901 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 11 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30981-5 | |
| OBX-3.2 | Text | Earliest Date to give | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 2 | |
| OBX-5 | Observation Value | 20160901 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 12 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30956-7 | |
| OBX-3.2 | Text | vaccine type | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 3 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 13 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59779-9 | |
| OBX-3.2 | Text | Immunization Schedule used | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 3 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 14 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30980-7 | |
| OBX-3.2 | Text | Date vaccination due | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 3 | |
| OBX-5 | Observation Value | 19960101 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 15 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30981-5 | |
| OBX-3.2 | Text | Earliest Date to give | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 3 | |
| OBX-5 | Observation Value | 19960101 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 16 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30956-7 | |
| OBX-3.2 | Text | vaccine type | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 4 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 17 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59779-9 | |
| OBX-3.2 | Text | Immunization Schedule used | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 4 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 18 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30980-7 | |
| OBX-3.2 | Text | Date vaccination due | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 4 | |
| OBX-5 | Observation Value | 19960101 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 19 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30981-5 | |
| OBX-3.2 | Text | Earliest Date to give | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 4 | |
| OBX-5 | Observation Value | 19960101 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 20 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30956-7 | |
| OBX-3.2 | Text | vaccine type | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 5 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 21 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59779-9 | |
| OBX-3.2 | Text | Immunization Schedule used | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 5 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 22 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30980-7 | |
| OBX-3.2 | Text | Date vaccination due | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 5 | |
| OBX-5 | Observation Value | 19950101 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 23 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30981-5 | |
| OBX-3.2 | Text | Earliest Date to give | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 5 | |
| OBX-5 | Observation Value | 19950101 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 24 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30956-7 | |
| OBX-3.2 | Text | vaccine type | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 6 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 25 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59779-9 | |
| OBX-3.2 | Text | Immunization Schedule used | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 6 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 26 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30980-7 | |
| OBX-3.2 | Text | Date vaccination due | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 6 | |
| OBX-5 | Observation Value | 20110101 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 27 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30981-5 | |
| OBX-3.2 | Text | Earliest Date to give | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 6 | |
| OBX-5 | Observation Value | 20110101 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 28 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30956-7 | |
| OBX-3.2 | Text | vaccine type | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 7 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 29 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59779-9 | |
| OBX-3.2 | Text | Immunization Schedule used | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 7 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 30 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30980-7 | |
| OBX-3.2 | Text | Date vaccination due | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 7 | |
| OBX-5 | Observation Value | 19960101 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 31 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30981-5 | |
| OBX-3.2 | Text | Earliest Date to give | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 7 | |
| OBX-5 | Observation Value | 19960101 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 32 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30956-7 | |
| OBX-3.2 | Text | vaccine type | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 8 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 33 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59779-9 | |
| OBX-3.2 | Text | Immunization Schedule used | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 8 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 34 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30980-7 | |
| OBX-3.2 | Text | Date vaccination due | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 8 | |
| OBX-5 | Observation Value | 20020101 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 35 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30981-5 | |
| OBX-3.2 | Text | Earliest Date to give | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 8 | |
| OBX-5 | Observation Value | 20020101 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | |
| MSH-2 | Encoding Characters | ^~\& | |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | NIST IIS APP | |
| MSH-3.2 | Universal ID | ||
| MSH-3.3 | Universal ID Type | ||
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | NIST IIS FAC | |
| MSH-4.2 | Universal ID | ||
| MSH-4.3 | Universal ID Type | ||
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | NIST EHR APP | |
| MSH-5.2 | Universal ID | ||
| MSH-5.3 | Universal ID Type | ||
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | NIST EHR Facility | |
| MSH-6.2 | Universal ID | ||
| MSH-6.3 | Universal ID Type | ||
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20141031145233-0500 | |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | RSP | |
| MSH-9.2 | Trigger Event | K11 | |
| MSH-9.3 | Message Structure | RSP_K11 | |
| MSH-10 | Message Control ID | NIST-IZ-QR-2.2_Response_K11_Z42 | |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | |
| MSH-15 | Accept Acknowledgment Type | NE | |
| MSH-16 | Application Acknowledgment Type | NE | |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z42 | |
| MSH-21.2 | Namespace ID | CDCPHINVS | |
| MSH-21.3 | Universal ID | ||
| MSH-21.4 | Universal ID Type | ||
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | NIST IIS FAC | |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | NIST-AA-1 | |
| MSH-22.6.2 | Universal ID | ||
| MSH-22.6.3 | Universal ID Type | ||
| MSH-22.7 | Identifier Type Code | XX | |
| MSH-22.10 | Organization Identifier | 100-1776 | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | NIST EHR Facility | |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | NIST-AA-1 | |
| MSH-23.6.2 | Universal ID | ||
| MSH-23.6.3 | Universal ID Type | ||
| MSH-23.7 | Identifier Type Code | XX | |
| MSH-23.10 | Organization Identifier | 100-6482 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA-1 | Acknowledgment Code | AA | |
| MSA-2 | Message Control ID | NIST-IZ-QR-2.1_Query_Q11_Z44 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QAK-1 | Query Tag | IZ-2.1-2015 | |
| QAK-2 | Query Response Status | OK | |
| QAK-3 | Message Query Name | ||
| QAK-3.1 | Identifier | Z44 | |
| QAK-3.2 | Text | request evaluated Immunization history | |
| QAK-3.3 | Name of Coding System | CDCPHINVS | |
| QAK-3.5 | Alternate Text | ||
| QAK-3.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD-1 | Message Query Name | ||
| QPD-1.1 | Identifier | Z44 | |
| QPD-1.2 | Text | Request Evaluated History and Forecast | |
| QPD-1.3 | Name of Coding System | CDCPHINVS | |
| QPD-1.5 | Alternate Text | ||
| QPD-1.6 | Name of Alternate Coding System | ||
| QPD-2 | Query Tag | IZ-2.1-2015 | |
| QPD-3 | PatientList | ||
| QPD-3.1 | ID Number | 648286 | |
| QPD-3.3 | Check Digit Scheme | ||
| QPD-3.4 | Assigning Authority | ||
| QPD-3.4.1 | Namespace ID | NIST MPI | |
| QPD-3.4.2 | Universal ID | ||
| QPD-3.4.3 | Universal ID Type | ||
| QPD-3.5 | Identifier Type Code | MR | |
| QPD-4 | PatientName | ||
| QPD-4.1 | Family Name | ||
| QPD-4.1.1 | Surname | Stanley | |
| QPD-4.1.2 | Own Surname Prefix | ||
| QPD-4.1.3 | Own Surname | ||
| QPD-4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD-4.1.5 | Surname From Partner/Spouse | ||
| QPD-4.2 | Given Name | Clement | |
| QPD-4.3 | Second and Further Given Names or Initials Thereof | S | |
| QPD-4.7 | Name Type Code | L | |
| QPD-5 | PatientMotherMaidenName | ||
| QPD-5.1 | Family Name | ||
| QPD-5.1.1 | Surname | Smith | |
| QPD-5.1.2 | Own Surname Prefix | ||
| QPD-5.1.3 | Own Surname | ||
| QPD-5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD-5.1.5 | Surname From Partner/Spouse | ||
| QPD-5.7 | Name Type Code | M | |
| QPD-6 | PatientDateOfBirth | ||
| QPD-6.1 | Time | 19500214 | |
| QPD-7 | Patient Sex | M | |
| QPD-8 | Patient Address | ||
| QPD-8.1 | Street Address | ||
| QPD-8.1.1 | Street or Mailing Address | 1642 Bear Run | |
| QPD-8.1.2 | Street Name | ||
| QPD-8.1.3 | Dwelling Number | ||
| QPD-8.2 | Other Designation | ||
| QPD-8.3 | City | Boseman | |
| QPD-8.4 | State or Province | MT | |
| QPD-8.5 | Zip or Postal Code | 59715 | |
| QPD-8.6 | Country | USA | |
| QPD-8.7 | Address Type | L | |
| QPD-9 | Phone | ||
| QPD-9.2 | Telecommunication Use Code | PRN | |
| QPD-9.3 | Telecommunication Equipment Type | PH | |
| QPD-9.4 | Email Address | ||
| QPD-9.6 | Area/City Code | 406 | |
| QPD-9.7 | Local Number | 5552020 | |
| QPD-10 | Multiple birth indicator | ||
| QPD-11 | Birth order |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| PID-1 | Set ID - PID | 1 | |
| PID-3[1] | Patient Identifier List | ||
| PID-3[1].1 | ID Number | 648286 | |
| PID-3[1].3 | Check Digit Scheme | ||
| PID-3[1].4 | Assigning Authority | ||
| PID-3[1].4.1 | Namespace ID | NIST MPI | |
| PID-3[1].4.2 | Universal ID | ||
| PID-3[1].4.3 | Universal ID Type | ||
| PID-3[1].5 | Identifier Type Code | MR | |
| PID-3[2] | Patient Identifier List | ||
| PID-3[2].1 | ID Number | 34500907 | |
| PID-3[2].3 | Check Digit Scheme | ||
| PID-3[2].4 | Assigning Authority | ||
| PID-3[2].4.1 | Namespace ID | IIS-AA | |
| PID-3[2].4.2 | Universal ID | ||
| PID-3[2].4.3 | Universal ID Type | ||
| PID-3[2].5 | Identifier Type Code | SR | |
| PID-5 | Patient Name | ||
| PID-5.1 | Family Name | ||
| PID-5.1.1 | Surname | Stanley | |
| PID-5.1.2 | Own Surname Prefix | ||
| PID-5.1.3 | Own Surname | ||
| PID-5.1.4 | Surname Prefix From Partner/Spouse | ||
| PID-5.1.5 | Surname From Partner/Spouse | ||
| PID-5.2 | Given Name | Clement | |
| PID-5.3 | Second and Further Given Names or Initials Thereof | S | |
| PID-5.7 | Name Type Code | L | |
| PID-7 | Date/Time of Birth | ||
| PID-7.1 | Time | 19950101 | |
| PID-8 | Administrative Sex | M | |
| PID-11 | Patient Address | ||
| PID-11.1 | Street Address | ||
| PID-11.1.1 | Street or Mailing Address | 1642 Bear Run | |
| PID-11.1.2 | Street Name | ||
| PID-11.1.3 | Dwelling Number | ||
| PID-11.2 | Other Designation | ||
| PID-11.3 | City | Bozeman | |
| PID-11.4 | State or Province | MT | |
| PID-11.5 | Zip or Postal Code | 59715 | |
| PID-11.6 | Country | USA | |
| PID-11.7 | Address Type | L | |
| PID-30 | Patient Death Indicator |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | ||
| ORC-2.2 | Namespace ID | ||
| ORC-2.3 | Universal ID | ||
| ORC-2.4 | Universal ID Type | ||
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 193337027 | |
| ORC-3.2 | Namespace ID | IIS-AA | |
| ORC-3.3 | Universal ID | ||
| ORC-3.4 | Universal ID Type | ||
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | ||
| ORC-17.2 | Text | ||
| ORC-17.3 | Name of Coding System | ||
| ORC-17.5 | Alternate Text | ||
| ORC-17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| ORC-1 | Order Control | RE | |
| ORC-2 | Placer Order Number | ||
| ORC-2.1 | Entity Identifier | ||
| ORC-2.2 | Namespace ID | ||
| ORC-2.3 | Universal ID | ||
| ORC-2.4 | Universal ID Type | ||
| ORC-3 | Filler Order Number | ||
| ORC-3.1 | Entity Identifier | 9999 | |
| ORC-3.2 | Namespace ID | DCS | |
| ORC-3.3 | Universal ID | ||
| ORC-3.4 | Universal ID Type | ||
| ORC-17 | Entering Organization | ||
| ORC-17.1 | Identifier | DCS | |
| ORC-17.2 | Text | Dabig Clinical System | |
| ORC-17.3 | Name of Coding System | HL70362 | |
| ORC-17.5 | Alternate Text | ||
| ORC-17.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | |
| RXA-2 | Administration Sub-ID Counter | 1 | |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20151029 | |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 140 | |
| RXA-5.2 | Text | seasonal flu | |
| RXA-5.3 | Name of Coding System | CVX | |
| RXA-5.5 | Alternate Text | ||
| RXA-5.6 | Name of Alternate Coding System | ||
| RXA-6 | Administered Amount | 0.5 | |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | mL | |
| RXA-7.2 | Text | ||
| RXA-7.3 | Name of Coding System | UCUM | |
| RXA-7.5 | Alternate Text | ||
| RXA-7.6 | Name of Alternate Coding System | ||
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | 00 | |
| RXA-9.2 | Text | new immunization record | |
| RXA-9.3 | Name of Coding System | NIP001 | |
| RXA-9.5 | Alternate Text | ||
| RXA-9.6 | Name of Alternate Coding System | ||
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | ||
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | Sticker | |
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | Nurse | |
| RXA-10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | ||
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | ||
| RXA-10.12 | Check Digit Scheme | ||
| RXA-10.13 | Identifier Type Code | ||
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | DCS_DC | |
| RXA-11.4.2 | Universal ID | ||
| RXA-11.4.3 | Universal ID Type | ||
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | ||
| RXA-18.2 | Text | ||
| RXA-18.3 | Name of Coding System | ||
| RXA-18.5 | Alternate Text | ||
| RXA-18.6 | Name of Alternate Coding System | ||
| RXA-20 | Completion Status | CP |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXA-1 | Give Sub-ID Counter | 0 | |
| RXA-2 | Administration Sub-ID Counter | 1 | |
| RXA-3 | Date/Time Start of Administration | ||
| RXA-3.1 | Time | 20151029 | |
| RXA-5 | Administered Code | ||
| RXA-5.1 | Identifier | 998 | |
| RXA-5.2 | Text | no vaccine admin | |
| RXA-5.3 | Name of Coding System | CVX | |
| RXA-5.5 | Alternate Text | ||
| RXA-5.6 | Name of Alternate Coding System | ||
| RXA-6 | Administered Amount | 999 | |
| RXA-7 | Administered Units | ||
| RXA-7.1 | Identifier | ||
| RXA-7.2 | Text | ||
| RXA-7.3 | Name of Coding System | ||
| RXA-7.5 | Alternate Text | ||
| RXA-7.6 | Name of Alternate Coding System | ||
| RXA-9 | Administration Notes | ||
| RXA-9.1 | Identifier | ||
| RXA-9.2 | Text | ||
| RXA-9.3 | Name of Coding System | ||
| RXA-9.5 | Alternate Text | ||
| RXA-9.6 | Name of Alternate Coding System | ||
| RXA-10 | Administering Provider | ||
| RXA-10.1 | ID Number | ||
| RXA-10.2 | Family Name | ||
| RXA-10.2.1 | Surname | ||
| RXA-10.2.2 | Own Surname Prefix | ||
| RXA-10.2.3 | Own Surname | ||
| RXA-10.2.4 | Surname Prefix From Partner/Spouse | ||
| RXA-10.2.5 | Surname From Partner/Spouse | ||
| RXA-10.3 | Given Name | ||
| RXA-10.4 | Second and Further Given Names or Initials Thereof | ||
| RXA-10.9 | Assigning Authority | ||
| RXA-10.9.1 | Namespace ID | ||
| RXA-10.9.2 | Universal ID | ||
| RXA-10.9.3 | Universal ID Type | ||
| RXA-10.10 | Name Type Code | ||
| RXA-10.12 | Check Digit Scheme | ||
| RXA-10.13 | Identifier Type Code | ||
| RXA-11 | Administered-at Location | ||
| RXA-11.4 | Facility | ||
| RXA-11.4.1 | Namespace ID | ||
| RXA-11.4.2 | Universal ID | ||
| RXA-11.4.3 | Universal ID Type | ||
| RXA-18 | Substance/Treatment Refusal Reason | ||
| RXA-18.1 | Identifier | ||
| RXA-18.2 | Text | ||
| RXA-18.3 | Name of Coding System | ||
| RXA-18.5 | Alternate Text | ||
| RXA-18.6 | Name of Alternate Coding System | ||
| RXA-20 | Completion Status | NA |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RXR-1 | Route | ||
| RXR-1.1 | Identifier | C28161 | |
| RXR-1.2 | Text | IM | |
| RXR-1.3 | Name of Coding System | NCIT | |
| RXR-1.5 | Alternate Text | ||
| RXR-1.6 | Name of Alternate Coding System | ||
| RXR-2 | Administration Site | ||
| RXR-2.1 | Identifier | ||
| RXR-2.2 | Text | ||
| RXR-2.3 | Name of Coding System | ||
| RXR-2.5 | Alternate Text | ||
| RXR-2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 1 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30956-7 | |
| OBX-3.2 | Text | vaccine type | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 2 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59779-9 | |
| OBX-3.2 | Text | Immunization Schedule used | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151029 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 3 | |
| OBX-2 | Value Type | ID | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59781-5 | |
| OBX-3.2 | Text | dose validity | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | Y | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time | 20151029 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 4 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30956-7 | |
| OBX-3.2 | Text | vaccine type | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 5 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59779-9 | |
| OBX-3.2 | Text | Immunization Schedule used | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 6 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30980-7 | |
| OBX-3.2 | Text | Date vaccination due | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | 20600101 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 7 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30981-5 | |
| OBX-3.2 | Text | Earliest Date to give | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 1 | |
| OBX-5 | Observation Value | 20600101 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 8 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30956-7 | |
| OBX-3.2 | Text | vaccine type | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 2 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 9 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59779-9 | |
| OBX-3.2 | Text | Immunization Schedule used | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 2 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 10 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30980-7 | |
| OBX-3.2 | Text | Date vaccination due | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 2 | |
| OBX-5 | Observation Value | 20160901 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 11 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30981-5 | |
| OBX-3.2 | Text | Earliest Date to give | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 2 | |
| OBX-5 | Observation Value | 20160901 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 12 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30956-7 | |
| OBX-3.2 | Text | vaccine type | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 3 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 13 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59779-9 | |
| OBX-3.2 | Text | Immunization Schedule used | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 3 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 14 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30980-7 | |
| OBX-3.2 | Text | Date vaccination due | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 3 | |
| OBX-5 | Observation Value | 19960101 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 15 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30981-5 | |
| OBX-3.2 | Text | Earliest Date to give | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 3 | |
| OBX-5 | Observation Value | 19960101 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 16 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30956-7 | |
| OBX-3.2 | Text | vaccine type | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 4 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 17 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59779-9 | |
| OBX-3.2 | Text | Immunization Schedule used | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 4 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 18 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30980-7 | |
| OBX-3.2 | Text | Date vaccination due | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 4 | |
| OBX-5 | Observation Value | 19960101 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 19 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30981-5 | |
| OBX-3.2 | Text | Earliest Date to give | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 4 | |
| OBX-5 | Observation Value | 19960101 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 20 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30956-7 | |
| OBX-3.2 | Text | vaccine type | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 5 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 21 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59779-9 | |
| OBX-3.2 | Text | Immunization Schedule used | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 5 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 22 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30980-7 | |
| OBX-3.2 | Text | Date vaccination due | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 5 | |
| OBX-5 | Observation Value | 19950101 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 23 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30981-5 | |
| OBX-3.2 | Text | Earliest Date to give | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 5 | |
| OBX-5 | Observation Value | 19950101 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 24 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30956-7 | |
| OBX-3.2 | Text | vaccine type | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 6 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 25 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59779-9 | |
| OBX-3.2 | Text | Immunization Schedule used | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 6 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 26 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30980-7 | |
| OBX-3.2 | Text | Date vaccination due | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 6 | |
| OBX-5 | Observation Value | 20110101 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 27 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30981-5 | |
| OBX-3.2 | Text | Earliest Date to give | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 6 | |
| OBX-5 | Observation Value | 20110101 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 28 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30956-7 | |
| OBX-3.2 | Text | vaccine type | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 7 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 29 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59779-9 | |
| OBX-3.2 | Text | Immunization Schedule used | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 7 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 30 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30980-7 | |
| OBX-3.2 | Text | Date vaccination due | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 7 | |
| OBX-5 | Observation Value | 19960101 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 31 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30981-5 | |
| OBX-3.2 | Text | Earliest Date to give | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 7 | |
| OBX-5 | Observation Value | 19960101 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 32 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30956-7 | |
| OBX-3.2 | Text | vaccine type | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 8 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 33 | |
| OBX-2 | Value Type | CE | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 59779-9 | |
| OBX-3.2 | Text | Immunization Schedule used | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 8 | |
| OBX-5 | Observation Value | ||
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 34 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30980-7 | |
| OBX-3.2 | Text | Date vaccination due | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 8 | |
| OBX-5 | Observation Value | 20020101 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| OBX-1 | Set ID - OBX | 35 | |
| OBX-2 | Value Type | DT | |
| OBX-3 | Observation Identifier | ||
| OBX-3.1 | Identifier | 30981-5 | |
| OBX-3.2 | Text | Earliest Date to give | |
| OBX-3.3 | Name of Coding System | LN | |
| OBX-3.5 | Alternate Text | ||
| OBX-3.6 | Name of Alternate Coding System | ||
| OBX-4 | Observation Sub-ID | 8 | |
| OBX-5 | Observation Value | 20020101 | |
| OBX-6 | Units | ||
| OBX-6.1 | Identifier | ||
| OBX-6.2 | Text | ||
| OBX-6.3 | Name of Coding System | ||
| OBX-6.5 | Alternate Text | ||
| OBX-6.6 | Name of Alternate Coding System | ||
| OBX-11 | Observation Result Status | F | |
| OBX-14 | Date/Time of the Observation | ||
| OBX-14.1 | Time |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Evaluated Immunization History and Immunization Forecast | |||||
|---|---|---|---|---|---|
| Test Case ID | IZ-QR-2_Query_Adult | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement (Pass/Fail) |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display required core data elements from the information received in the Evaluated Immunization History and Immunization Forecast Z42 response message. Additional data from the message or from the EHR are permitted to be displayed by the EHR. Grayed-out fields in the Juror Document indicate where no data for the data element indicated were included in the Z42 message for the given Test Case.
The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.
The Evaluated Immunization History and Immunization Forecast data shown in this Juror Document are derived from the Z42 message provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.
| Patient Information | ||||
|---|---|---|---|---|
| Patient Identifier | Patient Name | DOB | Gender | Tester Comment |
| 648286 | Clement S Stanley | 01/01/1995 | Male | |
| When displayed in the EHR with the Evaluated Immunization History and Immunization Forecast, these patient demographics data may be derived from either the received immunization message or the EHR patient record. When displaying demographics from the patient record, the EHR must be able to demonstrate a linkage between the demographics in the message (primarily the patient ID in PID-3.1) and the patient record used for display to ensure that the message was associated with the appropriate patient. | ||||
| Evaluated Immunization History and Immunization Forecast |
|---|
| Immunization Schedule Used | Tester Comment |
|---|---|
| ACIP |
| Evaluated Immunization History | ||||||
|---|---|---|---|---|---|---|
| Vaccine Group | Vaccine Administered | Date Administered | Valid Dose | Validity Reason | Completion Status* | Tester Comment |
| influenza NOS | seasonal flu | 10/29/2015 | YES | Complete | ||
| * "Completion Status" refers to the status of the dose of vaccine administered on the indicated date and may be interpreted as "Dose Status". A status of "Complete" means that the vaccine dose was "completely administered" as opposed to "partially administered". | ||||||
| Immunization Forecast | ||||
|---|---|---|---|---|
| Vaccine Group | Due Date | Earliest Date To Give | Latest Date to Give | Tester Comment |
| pcv NOS | 01/01/2060 | 01/01/2060 | ||
| influenza NOS | 09/01/2016 | 09/01/2016 | ||
| MMR | 01/01/1996 | 01/01/1996 | ||
| Hep A | 01/01/1996 | 01/01/1996 | ||
| Hep B | 01/01/1995 | 01/01/1995 | ||
| MCV | 01/01/2011 | 01/01/2011 | ||
| varicella | 01/01/1996 | 01/01/1996 | ||
| TDAP | 01/01/2002 | 01/01/2002 | ||
| Description |
|---|
| A female toddler, Donna Victoria Bee, is brought to the local clinic to determine what immunizations have been given and what immunizations are needed. A clinic staff member collects basic patient demographic information including name, date of birth, sex, and birth order (Donna was born 3rd in a triplet). A clinic provider uses this information to locate the patient's medical record. The staff member then uses the medical record and system capabilities to query the IIS to request an evaluated history and forecast for the patient. The IIS performs a search for Donna Victoria Bee and does not find a high-confidence match. The IIS returns a response message indicating no person found to the querying system. It is expected that the requesting system (e.g., EHR-S) process the response message and display some indication to the end user that no matches were found. |
| Comments |
|---|
| No Comments |
| Pre Condition |
|---|
| Person exists in the system with the complete demographics as provided in the Test Data Specification. Person has Medical Record Number (MR). Person does not have a record in the IIS, even though complete demographics are used in the query. |
| Post Condition |
|---|
| The clinician is provided some indication that no matches were found. |
| Test Objectives |
|---|
| Tests for a maximally valued query message, including use of OIDs, mother's maiden name, fully valued address, birth indicator and birth order. Test the capability of the EHR-S to process a response message that returns no persons found and to provide an indication to the end user. |
| Evaluation Criteria |
|---|
| Query Message: Message Validation Report Response Message: Juror Document. The EHR-S receives the response and alerts the clinician that no matches were found. |
| Notes for Testers |
|---|
| The NIST tool is simulating a response from the IIS. |
| Description |
|---|
| A female toddler, Donna Victoria Bee, is brought to the local clinic to determine what immunizations have been given and what immunizations are needed. A clinic staff member collects basic patient demographic information including name, date of birth, sex, and birth order (Donna was born 3rd in a triplet). A clinic provider uses this information to locate the patient's medical record. The staff member then uses the medical record and system capabilities to query the IIS to request an evaluated history and forecast for the patient. |
| Comments |
|---|
| Most of the test data is categorized as Test Case Fixed. It is important that the data is entered into the querying system as specified to enable linking the response message to the patient record. The sending (querying) system will need to accept a response indicating that no matches were found. |
| Pre Condition |
|---|
| Person exists in the system with the complete demographics as provided in the Test Data Specification. Person has Medical Record Number (MR). Person does not have a record in the IIS, even though complete demographics are used in the query. |
| Post Condition |
|---|
| A response message is returned in which no person record is found. |
| Test Objectives |
|---|
| Tests for a maximally valued query message, including use of OIDs, mother's maiden name, fully valued address, birth indicator and birth order. |
| Evaluation Criteria |
|---|
| Message Validation Report |
| Notes for Testers |
|---|
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | NIST EHR APP | Presence-Configuration |
| MSH-3.2 | Universal ID | 2.16.840.1.113883.3.72.5.22 | Indifferent |
| MSH-3.3 | Universal ID Type | ISO | Indifferent |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | NIST EHR Facility | Presence-Configuration |
| MSH-4.2 | Universal ID | 2.16.840.1.113883.3.72.5.23 | Indifferent |
| MSH-4.3 | Universal ID Type | ISO | Indifferent |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | NIST IIS APP | Presence-Configuration |
| MSH-5.2 | Universal ID | 2.16.840.1.113883.3.72.5.40.1 | Indifferent |
| MSH-5.3 | Universal ID Type | ISO | Indifferent |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | NIST IIS FAC | Presence-Configuration |
| MSH-6.2 | Universal ID | 2.16.840.1.113883.3.72.5.40.2 | Indifferent |
| MSH-6.3 | Universal ID Type | ISO | Indifferent |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150531145156-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | QBP | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | Q11 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | QBP_Q11 | Value-Profile Fixed |
| MSH-10 | Message Control ID | NIST-IZ-QR-3.1_Query_Q11_Z44 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | ER | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | AL | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z44 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Profile Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | NIST | Presence-Configuration |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | NIST-AA-1 | Indifferent |
| MSH-22.6.2 | Universal ID | 2.16.840.1.113883.3.72.5.30.1 | Indifferent |
| MSH-22.6.3 | Universal ID Type | ISO | Indifferent |
| MSH-22.7 | Identifier Type Code | XX | Indifferent |
| MSH-22.10 | Organization Identifier | 100-6478 | Indifferent |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | NIST | Presence-Configuration |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | NIST-AA-1 | Indifferent |
| MSH-23.6.2 | Universal ID | 2.16.840.1.113883.3.72.5.30.1 | Indifferent |
| MSH-23.6.3 | Universal ID Type | ISO | Indifferent |
| MSH-23.7 | Identifier Type Code | XX | Indifferent |
| MSH-23.10 | Organization Identifier | 100-6478 | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD-1 | Message Query Name | ||
| QPD-1.1 | Identifier | Z44 | Value-Test Case Fixed |
| QPD-1.2 | Text | Request Evaluated History and Forecast | Value-Test Case Fixed |
| QPD-1.3 | Name of Coding System | CDCPHINVS | Value-Profile Fixed |
| QPD-1.5 | Alternate Text | ||
| QPD-1.6 | Name of Alternate Coding System | ||
| QPD-2 | Query Tag | IZ-3.1-2015 | Presence-System Generated |
| QPD-3 | PatientList | ||
| QPD-3.1 | ID Number | 177993 | Value-Test Case Fixed |
| QPD-3.3 | Check Digit Scheme | ||
| QPD-3.4 | Assigning Authority | ||
| QPD-3.4.1 | Namespace ID | NIST MPI | Value-Test Case Fixed |
| QPD-3.4.2 | Universal ID | 2.16.840.1.113883.3.72.5.30.2 | Indifferent |
| QPD-3.4.3 | Universal ID Type | ISO | Indifferent |
| QPD-3.5 | Identifier Type Code | MR | Value-Test Case Fixed |
| QPD-4 | PatientName | ||
| QPD-4.1 | Family Name | ||
| QPD-4.1.1 | Surname | Bee | Value-Test Case Fixed |
| QPD-4.1.2 | Own Surname Prefix | ||
| QPD-4.1.3 | Own Surname | ||
| QPD-4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD-4.1.5 | Surname From Partner/Spouse | ||
| QPD-4.2 | Given Name | Donna | Value-Test Case Fixed |
| QPD-4.3 | Second and Further Given Names or Initials Thereof | Victoria | Value-Test Case Fixed |
| QPD-4.7 | Name Type Code | L | Value-Test Case Fixed |
| QPD-5 | PatientMotherMaidenName | ||
| QPD-5.1 | Family Name | ||
| QPD-5.1.1 | Surname | Goluchio | Value-Test Case Fixed |
| QPD-5.1.2 | Own Surname Prefix | ||
| QPD-5.1.3 | Own Surname | ||
| QPD-5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD-5.1.5 | Surname From Partner/Spouse | ||
| QPD-5.7 | Name Type Code | M | Value-Profile Fixed |
| QPD-6 | PatientDateOfBirth | ||
| QPD-6.1 | Time | 20120507 | Value-Test Case Fixed |
| QPD-7 | Patient Sex | F | Value-Test Case Fixed |
| QPD-8 | Patient Address | ||
| QPD-8.1 | Street Address | ||
| QPD-8.1.1 | Street or Mailing Address | 737 Everygreen Road | Value-Test Case Fixed |
| QPD-8.1.2 | Street Name | ||
| QPD-8.1.3 | Dwelling Number | ||
| QPD-8.2 | Other Designation | Suite 511 | Indifferent |
| QPD-8.3 | City | Livingston | Value-Test Case Fixed |
| QPD-8.4 | State or Province | MT | Value-Test Case Fixed |
| QPD-8.5 | Zip or Postal Code | 59047 | Value-Test Case Fixed |
| QPD-8.6 | Country | USA | Value-Test Case Fixed |
| QPD-8.7 | Address Type | L | Presence-Content Indifferent |
| QPD-9 | Phone | ||
| QPD-9.2 | Telecommunication Use Code | PRN | Value-Test Case Fixed |
| QPD-9.3 | Telecommunication Equipment Type | PH | Value-Test Case Fixed |
| QPD-9.4 | Email Address | ||
| QPD-9.6 | Area/City Code | 406 | Value-Test Case Fixed |
| QPD-9.7 | Local Number | 5553758 | Value-Test Case Fixed |
| QPD-10 | Multiple birth indicator | Y | Value-Test Case Fixed |
| QPD-11 | Birth order | 3 | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RCP-1 | Query Priority | I | Value-Profile Fixed |
| RCP-2 | Quantity Limited Request | ||
| RCP-2.1 | Quantity | 1 | Value-Test Case Fixed |
| RCP-2.2 | Units | ||
| RCP-2.2.1 | Identifier | RD | Value-Profile Fixed |
| RCP-2.2.2 | Text | Records | Value-Profile Fixed |
| RCP-2.2.3 | Name of Coding System | HL70126 | Value-Profile Fixed |
| RCP-2.2.4 | Alternate Identifier | ||
| RCP-2.2.5 | Alternate Text | ||
| RCP-2.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | NIST EHR APP | Presence-Configuration |
| MSH-3.2 | Universal ID | 2.16.840.1.113883.3.72.5.22 | Indifferent |
| MSH-3.3 | Universal ID Type | ISO | Indifferent |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | NIST EHR Facility | Presence-Configuration |
| MSH-4.2 | Universal ID | 2.16.840.1.113883.3.72.5.23 | Indifferent |
| MSH-4.3 | Universal ID Type | ISO | Indifferent |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | NIST IIS APP | Presence-Configuration |
| MSH-5.2 | Universal ID | 2.16.840.1.113883.3.72.5.40.1 | Indifferent |
| MSH-5.3 | Universal ID Type | ISO | Indifferent |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | NIST IIS FAC | Presence-Configuration |
| MSH-6.2 | Universal ID | 2.16.840.1.113883.3.72.5.40.2 | Indifferent |
| MSH-6.3 | Universal ID Type | ISO | Indifferent |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150531145156-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | QBP | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | Q11 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | QBP_Q11 | Value-Profile Fixed |
| MSH-10 | Message Control ID | NIST-IZ-QR-3.1_Query_Q11_Z44 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | ER | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | AL | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z44 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Profile Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | NIST | Presence-Configuration |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | NIST-AA-1 | Indifferent |
| MSH-22.6.2 | Universal ID | 2.16.840.1.113883.3.72.5.30.1 | Indifferent |
| MSH-22.6.3 | Universal ID Type | ISO | Indifferent |
| MSH-22.7 | Identifier Type Code | XX | Indifferent |
| MSH-22.10 | Organization Identifier | 100-6478 | Indifferent |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | NIST | Presence-Configuration |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | NIST-AA-1 | Indifferent |
| MSH-23.6.2 | Universal ID | 2.16.840.1.113883.3.72.5.30.1 | Indifferent |
| MSH-23.6.3 | Universal ID Type | ISO | Indifferent |
| MSH-23.7 | Identifier Type Code | XX | Indifferent |
| MSH-23.10 | Organization Identifier | 100-6478 | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD-1 | Message Query Name | ||
| QPD-1.1 | Identifier | Z44 | Value-Test Case Fixed |
| QPD-1.2 | Text | Request Evaluated History and Forecast | Value-Test Case Fixed |
| QPD-1.3 | Name of Coding System | CDCPHINVS | Value-Profile Fixed |
| QPD-1.5 | Alternate Text | ||
| QPD-1.6 | Name of Alternate Coding System | ||
| QPD-2 | Query Tag | IZ-3.1-2015 | Presence-System Generated |
| QPD-3 | PatientList | ||
| QPD-3.1 | ID Number | 177993 | Value-Test Case Fixed |
| QPD-3.3 | Check Digit Scheme | ||
| QPD-3.4 | Assigning Authority | ||
| QPD-3.4.1 | Namespace ID | NIST MPI | Value-Test Case Fixed |
| QPD-3.4.2 | Universal ID | 2.16.840.1.113883.3.72.5.30.2 | Indifferent |
| QPD-3.4.3 | Universal ID Type | ISO | Indifferent |
| QPD-3.5 | Identifier Type Code | MR | Value-Test Case Fixed |
| QPD-4 | PatientName | ||
| QPD-4.1 | Family Name | ||
| QPD-4.1.1 | Surname | Bee | Value-Test Case Fixed |
| QPD-4.1.2 | Own Surname Prefix | ||
| QPD-4.1.3 | Own Surname | ||
| QPD-4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD-4.1.5 | Surname From Partner/Spouse | ||
| QPD-4.2 | Given Name | Donna | Value-Test Case Fixed |
| QPD-4.3 | Second and Further Given Names or Initials Thereof | Victoria | Value-Test Case Fixed |
| QPD-4.7 | Name Type Code | L | Value-Test Case Fixed |
| QPD-5 | PatientMotherMaidenName | ||
| QPD-5.1 | Family Name | ||
| QPD-5.1.1 | Surname | Goluchio | Value-Test Case Fixed |
| QPD-5.1.2 | Own Surname Prefix | ||
| QPD-5.1.3 | Own Surname | ||
| QPD-5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD-5.1.5 | Surname From Partner/Spouse | ||
| QPD-5.7 | Name Type Code | M | Value-Profile Fixed |
| QPD-6 | PatientDateOfBirth | ||
| QPD-6.1 | Time | 20120507 | Value-Test Case Fixed |
| QPD-7 | Patient Sex | F | Value-Test Case Fixed |
| QPD-8 | Patient Address | ||
| QPD-8.1 | Street Address | ||
| QPD-8.1.1 | Street or Mailing Address | 737 Everygreen Road | Value-Test Case Fixed |
| QPD-8.1.2 | Street Name | ||
| QPD-8.1.3 | Dwelling Number | ||
| QPD-8.2 | Other Designation | Suite 511 | Indifferent |
| QPD-8.3 | City | Livingston | Value-Test Case Fixed |
| QPD-8.4 | State or Province | MT | Value-Test Case Fixed |
| QPD-8.5 | Zip or Postal Code | 59047 | Value-Test Case Fixed |
| QPD-8.6 | Country | USA | Value-Test Case Fixed |
| QPD-8.7 | Address Type | L | Presence-Content Indifferent |
| QPD-9 | Phone | ||
| QPD-9.2 | Telecommunication Use Code | PRN | Value-Test Case Fixed |
| QPD-9.3 | Telecommunication Equipment Type | PH | Value-Test Case Fixed |
| QPD-9.4 | Email Address | ||
| QPD-9.6 | Area/City Code | 406 | Value-Test Case Fixed |
| QPD-9.7 | Local Number | 5553758 | Value-Test Case Fixed |
| QPD-10 | Multiple birth indicator | Y | Value-Test Case Fixed |
| QPD-11 | Birth order | 3 | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RCP-1 | Query Priority | I | Value-Profile Fixed |
| RCP-2 | Quantity Limited Request | ||
| RCP-2.1 | Quantity | 1 | Value-Test Case Fixed |
| RCP-2.2 | Units | ||
| RCP-2.2.1 | Identifier | RD | Value-Profile Fixed |
| RCP-2.2.2 | Text | Records | Value-Profile Fixed |
| RCP-2.2.3 | Name of Coding System | HL70126 | Value-Profile Fixed |
| RCP-2.2.4 | Alternate Identifier | ||
| RCP-2.2.5 | Alternate Text | ||
| RCP-2.2.6 | Name of Alternate Coding System |
| Element | Data |
|---|---|
| Patient Name | Donna Victoria Bee |
| Mother's Maiden Name | Goluchio |
| ID Number | 177993 |
| Date/Time of Birth | 05/07/2012 |
| Sex | Female |
| Patient Address | 737 Everygreen Road Livingston MT 59047 USA |
| Patient Phone | (406)555-3758 |
| Birth Indicator | Y |
| Birth Order | 3 |
| Element | Data |
|---|---|
| Patient Name | Donna Victoria Bee |
| Mother's Maiden Name | Goluchio |
| ID Number | 177993 |
| Date/Time of Birth | 05/07/2012 |
| Sex | Female |
| Patient Address | 737 Everygreen Road Livingston MT 59047 USA |
| Patient Phone | (406)555-3758 |
| Birth Indicator | Y |
| Birth Order | 3 |
| Description |
|---|
| The IIS performs a search for Donna Victoria Bee and does not find a high-confidence match. The IIS returns a response message indicating no person found to the querying system. |
| Comments |
|---|
| No Comments |
| Pre Condition |
|---|
| The patient Donna Victoria Bee exists in the querying system (e.g., EHR-S) and a query was performed. The IIS (simulated by the NIST test tool) does not find a match for the person. |
| Post Condition |
|---|
| The response message is processed and the clinician is alerted to fact of no matches. |
| Test Objectives |
|---|
| Test the capability of the EHR-S to process a response message that returns no persons found and to provide an indication to the end user. |
| Evaluation Criteria |
|---|
| Juror Document. Clinician is notified of no match. |
| Notes for Testers |
|---|
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | |
| MSH-2 | Encoding Characters | ^~\& | |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | NIST IIS APP | |
| MSH-3.2 | Universal ID | 2.16.840.1.113883.3.72.5.40.1 | |
| MSH-3.3 | Universal ID Type | ISO | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | NIST IIS FAC | |
| MSH-4.2 | Universal ID | 2.16.840.1.113883.3.72.5.40.2 | |
| MSH-4.3 | Universal ID Type | ISO | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | NIST EHR APP | |
| MSH-5.2 | Universal ID | 2.16.840.1.113883.3.72.5.22 | |
| MSH-5.3 | Universal ID Type | ISO | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | NIST EHR Facility | |
| MSH-6.2 | Universal ID | 2.16.840.1.113883.3.72.5.23 | |
| MSH-6.3 | Universal ID Type | ISO | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20151031145233-0500 | |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | RSP | |
| MSH-9.2 | Trigger Event | K11 | |
| MSH-9.3 | Message Structure | RSP_K11 | |
| MSH-10 | Message Control ID | NIST-IZ-QR-3.2_Respons_NF_K11_Z33 | |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | |
| MSH-15 | Accept Acknowledgment Type | NE | |
| MSH-16 | Application Acknowledgment Type | NE | |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z33 | |
| MSH-21.2 | Namespace ID | CDCPHINVS | |
| MSH-21.3 | Universal ID | ||
| MSH-21.4 | Universal ID Type | ||
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | NIST IIS FAC | |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | NIST-AA-1 | |
| MSH-22.6.2 | Universal ID | ||
| MSH-22.6.3 | Universal ID Type | ||
| MSH-22.7 | Identifier Type Code | XX | |
| MSH-22.10 | Organization Identifier | 100-1776 | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | NIST EHR Facility | |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | NIST-AA-1 | |
| MSH-23.6.2 | Universal ID | ||
| MSH-23.6.3 | Universal ID Type | ||
| MSH-23.7 | Identifier Type Code | XX | |
| MSH-23.10 | Organization Identifier | 100-6482 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA-1 | Acknowledgment Code | AA | |
| MSA-2 | Message Control ID | NIST-IZ-QR-3.1_Query_Q11_Z44 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QAK-1 | Query Tag | IZ-3.1-2015 | |
| QAK-2 | Query Response Status | NF | |
| QAK-3 | Message Query Name | ||
| QAK-3.1 | Identifier | Z44 | |
| QAK-3.2 | Text | request evaluated Immunization history | |
| QAK-3.3 | Name of Coding System | CDCPHINVS | |
| QAK-3.5 | Alternate Text | ||
| QAK-3.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD-1 | Message Query Name | ||
| QPD-1.1 | Identifier | Z44 | |
| QPD-1.2 | Text | Request Evaluated History and Forecast | |
| QPD-1.3 | Name of Coding System | CDCPHINVS | |
| QPD-1.5 | Alternate Text | ||
| QPD-1.6 | Name of Alternate Coding System | ||
| QPD-2 | Query Tag | IZ-3.1-2015 | |
| QPD-3 | PatientList | ||
| QPD-3.1 | ID Number | 177993 | |
| QPD-3.3 | Check Digit Scheme | ||
| QPD-3.4 | Assigning Authority | ||
| QPD-3.4.1 | Namespace ID | NIST MPI | |
| QPD-3.4.2 | Universal ID | 2.16.840.1.113883.3.72.5.30.2 | |
| QPD-3.4.3 | Universal ID Type | ISO | |
| QPD-3.5 | Identifier Type Code | MR | |
| QPD-4 | PatientName | ||
| QPD-4.1 | Family Name | ||
| QPD-4.1.1 | Surname | Bee | |
| QPD-4.1.2 | Own Surname Prefix | ||
| QPD-4.1.3 | Own Surname | ||
| QPD-4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD-4.1.5 | Surname From Partner/Spouse | ||
| QPD-4.2 | Given Name | Donna | |
| QPD-4.3 | Second and Further Given Names or Initials Thereof | Victoria | |
| QPD-4.7 | Name Type Code | L | |
| QPD-5 | PatientMotherMaidenName | ||
| QPD-5.1 | Family Name | ||
| QPD-5.1.1 | Surname | Goluchio | |
| QPD-5.1.2 | Own Surname Prefix | ||
| QPD-5.1.3 | Own Surname | ||
| QPD-5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD-5.1.5 | Surname From Partner/Spouse | ||
| QPD-5.7 | Name Type Code | M | |
| QPD-6 | PatientDateOfBirth | ||
| QPD-6.1 | Time | 20120507 | |
| QPD-7 | Patient Sex | F | |
| QPD-8 | Patient Address | ||
| QPD-8.1 | Street Address | ||
| QPD-8.1.1 | Street or Mailing Address | 737 Everygreen Road | |
| QPD-8.1.2 | Street Name | ||
| QPD-8.1.3 | Dwelling Number | ||
| QPD-8.2 | Other Designation | Suite 511 | |
| QPD-8.3 | City | Livingston | |
| QPD-8.4 | State or Province | MT | |
| QPD-8.5 | Zip or Postal Code | 59047 | |
| QPD-8.6 | Country | USA | |
| QPD-8.7 | Address Type | L | |
| QPD-9 | Phone | ||
| QPD-9.2 | Telecommunication Use Code | PRN | |
| QPD-9.3 | Telecommunication Equipment Type | PH | |
| QPD-9.4 | Email Address | ||
| QPD-9.6 | Area/City Code | 406 | |
| QPD-9.7 | Local Number | 5553758 | |
| QPD-10 | Multiple birth indicator | Y | |
| QPD-11 | Birth order | 3 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | |
| MSH-2 | Encoding Characters | ^~\& | |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | NIST IIS APP | |
| MSH-3.2 | Universal ID | 2.16.840.1.113883.3.72.5.40.1 | |
| MSH-3.3 | Universal ID Type | ISO | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | NIST IIS FAC | |
| MSH-4.2 | Universal ID | 2.16.840.1.113883.3.72.5.40.2 | |
| MSH-4.3 | Universal ID Type | ISO | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | NIST EHR APP | |
| MSH-5.2 | Universal ID | 2.16.840.1.113883.3.72.5.22 | |
| MSH-5.3 | Universal ID Type | ISO | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | NIST EHR Facility | |
| MSH-6.2 | Universal ID | 2.16.840.1.113883.3.72.5.23 | |
| MSH-6.3 | Universal ID Type | ISO | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20151031145233-0500 | |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | RSP | |
| MSH-9.2 | Trigger Event | K11 | |
| MSH-9.3 | Message Structure | RSP_K11 | |
| MSH-10 | Message Control ID | NIST-IZ-QR-3.2_Respons_NF_K11_Z33 | |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | |
| MSH-15 | Accept Acknowledgment Type | NE | |
| MSH-16 | Application Acknowledgment Type | NE | |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z33 | |
| MSH-21.2 | Namespace ID | CDCPHINVS | |
| MSH-21.3 | Universal ID | ||
| MSH-21.4 | Universal ID Type | ||
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | NIST IIS FAC | |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | NIST-AA-1 | |
| MSH-22.6.2 | Universal ID | ||
| MSH-22.6.3 | Universal ID Type | ||
| MSH-22.7 | Identifier Type Code | XX | |
| MSH-22.10 | Organization Identifier | 100-1776 | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | NIST EHR Facility | |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | NIST-AA-1 | |
| MSH-23.6.2 | Universal ID | ||
| MSH-23.6.3 | Universal ID Type | ||
| MSH-23.7 | Identifier Type Code | XX | |
| MSH-23.10 | Organization Identifier | 100-6482 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA-1 | Acknowledgment Code | AA | |
| MSA-2 | Message Control ID | NIST-IZ-QR-3.1_Query_Q11_Z44 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QAK-1 | Query Tag | IZ-3.1-2015 | |
| QAK-2 | Query Response Status | NF | |
| QAK-3 | Message Query Name | ||
| QAK-3.1 | Identifier | Z44 | |
| QAK-3.2 | Text | request evaluated Immunization history | |
| QAK-3.3 | Name of Coding System | CDCPHINVS | |
| QAK-3.5 | Alternate Text | ||
| QAK-3.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD-1 | Message Query Name | ||
| QPD-1.1 | Identifier | Z44 | |
| QPD-1.2 | Text | Request Evaluated History and Forecast | |
| QPD-1.3 | Name of Coding System | CDCPHINVS | |
| QPD-1.5 | Alternate Text | ||
| QPD-1.6 | Name of Alternate Coding System | ||
| QPD-2 | Query Tag | IZ-3.1-2015 | |
| QPD-3 | PatientList | ||
| QPD-3.1 | ID Number | 177993 | |
| QPD-3.3 | Check Digit Scheme | ||
| QPD-3.4 | Assigning Authority | ||
| QPD-3.4.1 | Namespace ID | NIST MPI | |
| QPD-3.4.2 | Universal ID | 2.16.840.1.113883.3.72.5.30.2 | |
| QPD-3.4.3 | Universal ID Type | ISO | |
| QPD-3.5 | Identifier Type Code | MR | |
| QPD-4 | PatientName | ||
| QPD-4.1 | Family Name | ||
| QPD-4.1.1 | Surname | Bee | |
| QPD-4.1.2 | Own Surname Prefix | ||
| QPD-4.1.3 | Own Surname | ||
| QPD-4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD-4.1.5 | Surname From Partner/Spouse | ||
| QPD-4.2 | Given Name | Donna | |
| QPD-4.3 | Second and Further Given Names or Initials Thereof | Victoria | |
| QPD-4.7 | Name Type Code | L | |
| QPD-5 | PatientMotherMaidenName | ||
| QPD-5.1 | Family Name | ||
| QPD-5.1.1 | Surname | Goluchio | |
| QPD-5.1.2 | Own Surname Prefix | ||
| QPD-5.1.3 | Own Surname | ||
| QPD-5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD-5.1.5 | Surname From Partner/Spouse | ||
| QPD-5.7 | Name Type Code | M | |
| QPD-6 | PatientDateOfBirth | ||
| QPD-6.1 | Time | 20120507 | |
| QPD-7 | Patient Sex | F | |
| QPD-8 | Patient Address | ||
| QPD-8.1 | Street Address | ||
| QPD-8.1.1 | Street or Mailing Address | 737 Everygreen Road | |
| QPD-8.1.2 | Street Name | ||
| QPD-8.1.3 | Dwelling Number | ||
| QPD-8.2 | Other Designation | Suite 511 | |
| QPD-8.3 | City | Livingston | |
| QPD-8.4 | State or Province | MT | |
| QPD-8.5 | Zip or Postal Code | 59047 | |
| QPD-8.6 | Country | USA | |
| QPD-8.7 | Address Type | L | |
| QPD-9 | Phone | ||
| QPD-9.2 | Telecommunication Use Code | PRN | |
| QPD-9.3 | Telecommunication Equipment Type | PH | |
| QPD-9.4 | Email Address | ||
| QPD-9.6 | Area/City Code | 406 | |
| QPD-9.7 | Local Number | 5553758 | |
| QPD-10 | Multiple birth indicator | Y | |
| QPD-11 | Birth order | 3 |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Evaluated Immunization History and Immunization Forecast | |||||
|---|---|---|---|---|---|
| Test Case ID | IZ-QR-3_Query_No_Patients | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement (Pass/Fail) |
|
||||
| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display information notifying the HIT user that a Return Acknowledgement with No Person Records Z33 message was received (in response to an Evaluated Immunization History and Immunization Forecast Z44 query message). Additional data from the message or from the EHR are petermitted to be displayed by the EHR.
The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.
The data shown in this Juror Document are derived from the test data provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.
| Patient Information | ||||
|---|---|---|---|---|
| Patient Identifier | Patient Name | DOB | Gender | Tester Comment |
| 177993 | Donna Victoria Bee | 05/07/2012 | Female | |
| When displayed in the EHR with the notification indicating that a Return Acknowledgement with No Person Records Z33 message was received, these patient demographics data are derived from the EHR patient record. | ||||
| Evaluated Immunization History and Immunization Forecast |
|---|
| The EHR shall display a notification indicating that the query for an Evaluated Immunization History and Immunization Forecast is complete but no matching records were found for the person in the query. |
| Description |
|---|
| A child, James Smith, is brought to the local clinic to determine what immunizations have been given and what immunizations are needed. A clinic staff member collects basic patient demographic information including name, date of birth and sex. A clinic provider uses this information to locate the patient's medical record. The staff member then uses the medical record and system capabilities to query the IIS to request an evaluated history and forecast for the patient. The IIS performs a search for James Smith and finds too many matches. The IIS returns a response message indicating no person found (too many matches) to the querying system. It is expected that the requesting system (e.g., EHR-S) process the response message and display some indication to the end user that the person was not found (too many matches). |
| Comments |
|---|
| Pre Condition |
|---|
| Person exists in the system with the complete demographics as provided in the Test Data Specification. Person has Medical Record Number (MR). Person may have a record in the IIS, however the IIS is unable narrow the search results to a single match (multiple matches exist). |
| Post Condition |
|---|
| The clinician is provided some indication that too many matches were found. |
| Test Objectives |
|---|
| Tests for a typically valued query message. Test the capability of the EHR-S to process a response message that returns no persons found (too many matches) and to provide an indication to the end user. |
| Evaluation Criteria |
|---|
| Query Message: Message Validation Report Response Message: Juror Document. The EHR-S receives the response and alerts the clinician that too many matches were found. |
| Notes for Testers |
|---|
| The NIST tool is simulating a response from the IIS. |
| Description |
|---|
| A child, James Smith, is brought to the local clinic to determine what immunizations have been given and what immunizations are needed. A clinic staff member collects basic patient demographic information including name, date of birth and sex. A clinic provider uses this information to locate the patient's medical record. The staff member then uses the medical record and system capabilities to query the IIS to request an evaluated history and forecast for the patient. |
| Comments |
|---|
| Most of the test data is categorized as Test Case Fixed. It is important that the data is entered into the querying system as specified to enable linking the response message to the patient record. The sending (querying) system will need to accept a response indicating that too many matches were found. |
| Pre Condition |
|---|
| More than one person in the IIS matching the parameters in the query exists. |
| Post Condition |
|---|
| Response indicates that there are more than one match (too many) and the clinician is informed. |
| Test Objectives |
|---|
| Tests for a typically valued query message. |
| Evaluation Criteria |
|---|
| Message Validation Report |
| Notes for Testers |
|---|
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | NIST EHR APP | Presence-Configuration |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | NIST EHR Facility | Presence-Configuration |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | NIST IIS APP | Presence-Configuration |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | NIST IIS FAC | Presence-Configuration |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150531145156-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | QBP | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | Q11 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | QBP_Q11 | Value-Profile Fixed |
| MSH-10 | Message Control ID | NIST-IZ-4.1_Query_Q11_Z44 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | ER | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | AL | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z44 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Profile Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | NIST EHR Facility | Presence-Configuration |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | NIST-AA-1 | Indifferent |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | XX | Indifferent |
| MSH-22.10 | Organization Identifier | 100-6482 | Indifferent |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | NIST IIS FAC | Presence-Configuration |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | NIST-AA-1 | Indifferent |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | XX | Indifferent |
| MSH-23.10 | Organization Identifier | 100-1776 | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD-1 | Message Query Name | ||
| QPD-1.1 | Identifier | Z44 | Value-Test Case Fixed |
| QPD-1.2 | Text | Request Evaluated History and Forecast | Value-Test Case Fixed |
| QPD-1.3 | Name of Coding System | CDCPHINVS | Value-Profile Fixed |
| QPD-1.5 | Alternate Text | ||
| QPD-1.6 | Name of Alternate Coding System | ||
| QPD-2 | Query Tag | IZ-4.1-2015 | Presence-System Generated |
| QPD-3 | PatientList | ||
| QPD-3.1 | ID Number | 412299 | Value-Test Case Fixed |
| QPD-3.3 | Check Digit Scheme | ||
| QPD-3.4 | Assigning Authority | ||
| QPD-3.4.1 | Namespace ID | NIST MPI | Value-Test Case Fixed |
| QPD-3.4.2 | Universal ID | Indifferent | |
| QPD-3.4.3 | Universal ID Type | Indifferent | |
| QPD-3.5 | Identifier Type Code | MR | Value-Test Case Fixed |
| QPD-4 | PatientName | ||
| QPD-4.1 | Family Name | ||
| QPD-4.1.1 | Surname | Smith | Value-Test Case Fixed |
| QPD-4.1.2 | Own Surname Prefix | ||
| QPD-4.1.3 | Own Surname | ||
| QPD-4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD-4.1.5 | Surname From Partner/Spouse | ||
| QPD-4.2 | Given Name | James | Value-Test Case Fixed |
| QPD-4.3 | Second and Further Given Names or Initials Thereof | Value-Test Case Fixed | |
| QPD-4.7 | Name Type Code | L | Value-Test Case Fixed |
| QPD-5 | PatientMotherMaidenName | ||
| QPD-5.1 | Family Name | ||
| QPD-5.1.1 | Surname | Value-Test Case Fixed | |
| QPD-5.1.2 | Own Surname Prefix | ||
| QPD-5.1.3 | Own Surname | ||
| QPD-5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD-5.1.5 | Surname From Partner/Spouse | ||
| QPD-5.7 | Name Type Code | Value-Profile Fixed | |
| QPD-6 | PatientDateOfBirth | ||
| QPD-6.1 | Time | 20110905 | Value-Test Case Fixed |
| QPD-7 | Patient Sex | M | Value-Test Case Fixed |
| QPD-8 | Patient Address | ||
| QPD-8.1 | Street Address | ||
| QPD-8.1.1 | Street or Mailing Address | 22 East Branch Way | Value-Test Case Fixed |
| QPD-8.1.2 | Street Name | ||
| QPD-8.1.3 | Dwelling Number | ||
| QPD-8.2 | Other Designation | Indifferent | |
| QPD-8.3 | City | Livingston | Value-Test Case Fixed |
| QPD-8.4 | State or Province | MT | Value-Test Case Fixed |
| QPD-8.5 | Zip or Postal Code | 59047 | Value-Test Case Fixed |
| QPD-8.6 | Country | Value-Test Case Fixed | |
| QPD-8.7 | Address Type | L | Presence-Content Indifferent |
| QPD-9 | Phone | ||
| QPD-9.2 | Telecommunication Use Code | PRN | Value-Test Case Fixed |
| QPD-9.3 | Telecommunication Equipment Type | PH | Value-Test Case Fixed |
| QPD-9.4 | Email Address | ||
| QPD-9.6 | Area/City Code | 406 | Value-Test Case Fixed |
| QPD-9.7 | Local Number | 5556285 | Value-Test Case Fixed |
| QPD-10 | Multiple birth indicator | Value-Test Case Fixed | |
| QPD-11 | Birth order | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RCP-1 | Query Priority | I | Value-Profile Fixed |
| RCP-2 | Quantity Limited Request | ||
| RCP-2.1 | Quantity | 1 | Value-Test Case Fixed |
| RCP-2.2 | Units | ||
| RCP-2.2.1 | Identifier | RD | Value-Profile Fixed |
| RCP-2.2.2 | Text | Records | Value-Profile Fixed |
| RCP-2.2.3 | Name of Coding System | HL70126 | Value-Profile Fixed |
| RCP-2.2.4 | Alternate Identifier | ||
| RCP-2.2.5 | Alternate Text | ||
| RCP-2.2.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | Value-Profile Fixed |
| MSH-2 | Encoding Characters | ^~\& | Value-Profile Fixed |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | NIST EHR APP | Presence-Configuration |
| MSH-3.2 | Universal ID | Indifferent | |
| MSH-3.3 | Universal ID Type | Indifferent | |
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | NIST EHR Facility | Presence-Configuration |
| MSH-4.2 | Universal ID | Indifferent | |
| MSH-4.3 | Universal ID Type | Indifferent | |
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | NIST IIS APP | Presence-Configuration |
| MSH-5.2 | Universal ID | Indifferent | |
| MSH-5.3 | Universal ID Type | Indifferent | |
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | NIST IIS FAC | Presence-Configuration |
| MSH-6.2 | Universal ID | Indifferent | |
| MSH-6.3 | Universal ID Type | Indifferent | |
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20150531145156-0500 | Presence-System Generated |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | QBP | Value-Profile Fixed |
| MSH-9.2 | Trigger Event | Q11 | Value-Profile Fixed |
| MSH-9.3 | Message Structure | QBP_Q11 | Value-Profile Fixed |
| MSH-10 | Message Control ID | NIST-IZ-4.1_Query_Q11_Z44 | Presence-System Generated |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | Presence-Content Indifferent |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | Value-Profile Fixed |
| MSH-15 | Accept Acknowledgment Type | ER | Value-Profile Fixed |
| MSH-16 | Application Acknowledgment Type | AL | Value-Profile Fixed |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z44 | Value-Test Case Fixed |
| MSH-21.2 | Namespace ID | CDCPHINVS | Value-Profile Fixed |
| MSH-21.3 | Universal ID | Indifferent | |
| MSH-21.4 | Universal ID Type | Indifferent | |
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | NIST EHR Facility | Presence-Configuration |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | NIST-AA-1 | Indifferent |
| MSH-22.6.2 | Universal ID | Indifferent | |
| MSH-22.6.3 | Universal ID Type | Indifferent | |
| MSH-22.7 | Identifier Type Code | XX | Indifferent |
| MSH-22.10 | Organization Identifier | 100-6482 | Indifferent |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | NIST IIS FAC | Presence-Configuration |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | NIST-AA-1 | Indifferent |
| MSH-23.6.2 | Universal ID | Indifferent | |
| MSH-23.6.3 | Universal ID Type | Indifferent | |
| MSH-23.7 | Identifier Type Code | XX | Indifferent |
| MSH-23.10 | Organization Identifier | 100-1776 | Indifferent |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD-1 | Message Query Name | ||
| QPD-1.1 | Identifier | Z44 | Value-Test Case Fixed |
| QPD-1.2 | Text | Request Evaluated History and Forecast | Value-Test Case Fixed |
| QPD-1.3 | Name of Coding System | CDCPHINVS | Value-Profile Fixed |
| QPD-1.5 | Alternate Text | ||
| QPD-1.6 | Name of Alternate Coding System | ||
| QPD-2 | Query Tag | IZ-4.1-2015 | Presence-System Generated |
| QPD-3 | PatientList | ||
| QPD-3.1 | ID Number | 412299 | Value-Test Case Fixed |
| QPD-3.3 | Check Digit Scheme | ||
| QPD-3.4 | Assigning Authority | ||
| QPD-3.4.1 | Namespace ID | NIST MPI | Value-Test Case Fixed |
| QPD-3.4.2 | Universal ID | Indifferent | |
| QPD-3.4.3 | Universal ID Type | Indifferent | |
| QPD-3.5 | Identifier Type Code | MR | Value-Test Case Fixed |
| QPD-4 | PatientName | ||
| QPD-4.1 | Family Name | ||
| QPD-4.1.1 | Surname | Smith | Value-Test Case Fixed |
| QPD-4.1.2 | Own Surname Prefix | ||
| QPD-4.1.3 | Own Surname | ||
| QPD-4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD-4.1.5 | Surname From Partner/Spouse | ||
| QPD-4.2 | Given Name | James | Value-Test Case Fixed |
| QPD-4.3 | Second and Further Given Names or Initials Thereof | Value-Test Case Fixed | |
| QPD-4.7 | Name Type Code | L | Value-Test Case Fixed |
| QPD-5 | PatientMotherMaidenName | ||
| QPD-5.1 | Family Name | ||
| QPD-5.1.1 | Surname | Value-Test Case Fixed | |
| QPD-5.1.2 | Own Surname Prefix | ||
| QPD-5.1.3 | Own Surname | ||
| QPD-5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD-5.1.5 | Surname From Partner/Spouse | ||
| QPD-5.7 | Name Type Code | Value-Profile Fixed | |
| QPD-6 | PatientDateOfBirth | ||
| QPD-6.1 | Time | 20110905 | Value-Test Case Fixed |
| QPD-7 | Patient Sex | M | Value-Test Case Fixed |
| QPD-8 | Patient Address | ||
| QPD-8.1 | Street Address | ||
| QPD-8.1.1 | Street or Mailing Address | 22 East Branch Way | Value-Test Case Fixed |
| QPD-8.1.2 | Street Name | ||
| QPD-8.1.3 | Dwelling Number | ||
| QPD-8.2 | Other Designation | Indifferent | |
| QPD-8.3 | City | Livingston | Value-Test Case Fixed |
| QPD-8.4 | State or Province | MT | Value-Test Case Fixed |
| QPD-8.5 | Zip or Postal Code | 59047 | Value-Test Case Fixed |
| QPD-8.6 | Country | Value-Test Case Fixed | |
| QPD-8.7 | Address Type | L | Presence-Content Indifferent |
| QPD-9 | Phone | ||
| QPD-9.2 | Telecommunication Use Code | PRN | Value-Test Case Fixed |
| QPD-9.3 | Telecommunication Equipment Type | PH | Value-Test Case Fixed |
| QPD-9.4 | Email Address | ||
| QPD-9.6 | Area/City Code | 406 | Value-Test Case Fixed |
| QPD-9.7 | Local Number | 5556285 | Value-Test Case Fixed |
| QPD-10 | Multiple birth indicator | Value-Test Case Fixed | |
| QPD-11 | Birth order | Value-Test Case Fixed |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| RCP-1 | Query Priority | I | Value-Profile Fixed |
| RCP-2 | Quantity Limited Request | ||
| RCP-2.1 | Quantity | 1 | Value-Test Case Fixed |
| RCP-2.2 | Units | ||
| RCP-2.2.1 | Identifier | RD | Value-Profile Fixed |
| RCP-2.2.2 | Text | Records | Value-Profile Fixed |
| RCP-2.2.3 | Name of Coding System | HL70126 | Value-Profile Fixed |
| RCP-2.2.4 | Alternate Identifier | ||
| RCP-2.2.5 | Alternate Text | ||
| RCP-2.2.6 | Name of Alternate Coding System |
| Element | Data |
|---|---|
| Patient Name | James Smith |
| Mother's Maiden Name | |
| ID Number | 412299 |
| Date/Time of Birth | 09/05/2011 |
| Sex | Male |
| Patient Address | 22 East Branch Way Livingston MT 59047 |
| Patient Phone | (406)555-6285 |
| Birth Indicator | |
| Birth Order |
| Element | Data |
|---|---|
| Patient Name | James Smith |
| Mother's Maiden Name | |
| ID Number | 412299 |
| Date/Time of Birth | 09/05/2011 |
| Sex | Male |
| Patient Address | 22 East Branch Way Livingston MT 59047 |
| Patient Phone | (406)555-6285 |
| Birth Indicator | |
| Birth Order |
| Description |
|---|
| The IIS performs a search for James Smith and finds too many matches based on the sending system's query (e.g., EHR-S). The IIS returns a response message indicating no person found (too many matches) to the querying system. It is expected that the requesting system (e.g., EHR-S) process the response message and display some indication to the end user that the person was not found (too many matches). |
| Comments |
|---|
| No Comments |
| Pre Condition |
|---|
| A query is made to the IIS. Person may have a record in the IIS, however the IIS is unable narrow the search results to a single match (multiple matches exist). |
| Post Condition |
|---|
| The clinician is provided some indication that too many matches were found. |
| Test Objectives |
|---|
| Test the capability of the EHR-S to process a response message that returns no persons found (too many matches) and to provide an indication to the end user. |
| Evaluation Criteria |
|---|
| Juror Document. Clinician is notified that too many matches were found. |
| Notes for Testers |
|---|
| No Note |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | |
| MSH-2 | Encoding Characters | ^~\& | |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | NIST IIS APP | |
| MSH-3.2 | Universal ID | ||
| MSH-3.3 | Universal ID Type | ||
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | NIST IIS FAC | |
| MSH-4.2 | Universal ID | ||
| MSH-4.3 | Universal ID Type | ||
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | NIST EHR APP | |
| MSH-5.2 | Universal ID | ||
| MSH-5.3 | Universal ID Type | ||
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | NIST EHR Facility | |
| MSH-6.2 | Universal ID | ||
| MSH-6.3 | Universal ID Type | ||
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20141031145233-0500 | |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | RSP | |
| MSH-9.2 | Trigger Event | K11 | |
| MSH-9.3 | Message Structure | RSP_K11 | |
| MSH-10 | Message Control ID | NIST-IZ-QR-4.2_Response_K11_Z33 | |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | |
| MSH-15 | Accept Acknowledgment Type | NE | |
| MSH-16 | Application Acknowledgment Type | NE | |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z33 | |
| MSH-21.2 | Namespace ID | CDCPHINVS | |
| MSH-21.3 | Universal ID | ||
| MSH-21.4 | Universal ID Type | ||
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | NIST IIS FAC | |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | NIST-AA-1 | |
| MSH-22.6.2 | Universal ID | ||
| MSH-22.6.3 | Universal ID Type | ||
| MSH-22.7 | Identifier Type Code | XX | |
| MSH-22.10 | Organization Identifier | 100-1776 | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | NIST EHR Facility | |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | NIST-AA-1 | |
| MSH-23.6.2 | Universal ID | ||
| MSH-23.6.3 | Universal ID Type | ||
| MSH-23.7 | Identifier Type Code | XX | |
| MSH-23.10 | Organization Identifier | 100-6482 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA-1 | Acknowledgment Code | AA | |
| MSA-2 | Message Control ID | NIST-IZ-4.1_Query_Q11_Z44 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QAK-1 | Query Tag | IZ-4.1-2015 | |
| QAK-2 | Query Response Status | TM | |
| QAK-3 | Message Query Name | ||
| QAK-3.1 | Identifier | Z44 | |
| QAK-3.2 | Text | request evaluated Immunization history | |
| QAK-3.3 | Name of Coding System | CDCPHINVS | |
| QAK-3.5 | Alternate Text | ||
| QAK-3.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD-1 | Message Query Name | ||
| QPD-1.1 | Identifier | Z44 | |
| QPD-1.2 | Text | Request Evaluated History and Forecast | |
| QPD-1.3 | Name of Coding System | CDCPHINVS | |
| QPD-1.5 | Alternate Text | ||
| QPD-1.6 | Name of Alternate Coding System | ||
| QPD-2 | Query Tag | IZ-4.1-2015 | |
| QPD-3 | PatientList | ||
| QPD-3.1 | ID Number | 412299 | |
| QPD-3.3 | Check Digit Scheme | ||
| QPD-3.4 | Assigning Authority | ||
| QPD-3.4.1 | Namespace ID | NIST MPI | |
| QPD-3.4.2 | Universal ID | ||
| QPD-3.4.3 | Universal ID Type | ||
| QPD-3.5 | Identifier Type Code | MR | |
| QPD-4 | PatientName | ||
| QPD-4.1 | Family Name | ||
| QPD-4.1.1 | Surname | Smith | |
| QPD-4.1.2 | Own Surname Prefix | ||
| QPD-4.1.3 | Own Surname | ||
| QPD-4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD-4.1.5 | Surname From Partner/Spouse | ||
| QPD-4.2 | Given Name | James | |
| QPD-4.3 | Second and Further Given Names or Initials Thereof | ||
| QPD-4.7 | Name Type Code | L | |
| QPD-5 | PatientMotherMaidenName | ||
| QPD-5.1 | Family Name | ||
| QPD-5.1.1 | Surname | ||
| QPD-5.1.2 | Own Surname Prefix | ||
| QPD-5.1.3 | Own Surname | ||
| QPD-5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD-5.1.5 | Surname From Partner/Spouse | ||
| QPD-5.7 | Name Type Code | ||
| QPD-6 | PatientDateOfBirth | ||
| QPD-6.1 | Time | 20110905 | |
| QPD-7 | Patient Sex | M | |
| QPD-8 | Patient Address | ||
| QPD-8.1 | Street Address | ||
| QPD-8.1.1 | Street or Mailing Address | 22 East Branch Way | |
| QPD-8.1.2 | Street Name | ||
| QPD-8.1.3 | Dwelling Number | ||
| QPD-8.2 | Other Designation | ||
| QPD-8.3 | City | Livingston | |
| QPD-8.4 | State or Province | MT | |
| QPD-8.5 | Zip or Postal Code | 59047 | |
| QPD-8.6 | Country | ||
| QPD-8.7 | Address Type | L | |
| QPD-9 | Phone | ||
| QPD-9.2 | Telecommunication Use Code | PRN | |
| QPD-9.3 | Telecommunication Equipment Type | PH | |
| QPD-9.4 | Email Address | ||
| QPD-9.6 | Area/City Code | 406 | |
| QPD-9.7 | Local Number | 5556285 | |
| QPD-10 | Multiple birth indicator | ||
| QPD-11 | Birth order |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSH-1 | Field Separator | | | |
| MSH-2 | Encoding Characters | ^~\& | |
| MSH-3 | Sending Application | ||
| MSH-3.1 | Namespace ID | NIST IIS APP | |
| MSH-3.2 | Universal ID | ||
| MSH-3.3 | Universal ID Type | ||
| MSH-4 | Sending Facility | ||
| MSH-4.1 | Namespace ID | NIST IIS FAC | |
| MSH-4.2 | Universal ID | ||
| MSH-4.3 | Universal ID Type | ||
| MSH-5 | Receiving Application | ||
| MSH-5.1 | Namespace ID | NIST EHR APP | |
| MSH-5.2 | Universal ID | ||
| MSH-5.3 | Universal ID Type | ||
| MSH-6 | Receiving Facility | ||
| MSH-6.1 | Namespace ID | NIST EHR Facility | |
| MSH-6.2 | Universal ID | ||
| MSH-6.3 | Universal ID Type | ||
| MSH-7 | Date/Time Of Message | ||
| MSH-7.1 | Time | 20141031145233-0500 | |
| MSH-9 | Message Type | ||
| MSH-9.1 | Message Code | RSP | |
| MSH-9.2 | Trigger Event | K11 | |
| MSH-9.3 | Message Structure | RSP_K11 | |
| MSH-10 | Message Control ID | NIST-IZ-QR-4.2_Response_K11_Z33 | |
| MSH-11 | Processing ID | ||
| MSH-11.1 | Processing ID | P | |
| MSH-12 | Version ID | ||
| MSH-12.1 | Version ID | 2.5.1 | |
| MSH-15 | Accept Acknowledgment Type | NE | |
| MSH-16 | Application Acknowledgment Type | NE | |
| MSH-21 | Message Profile Identifier | ||
| MSH-21.1 | Entity Identifier | Z33 | |
| MSH-21.2 | Namespace ID | CDCPHINVS | |
| MSH-21.3 | Universal ID | ||
| MSH-21.4 | Universal ID Type | ||
| MSH-22 | Sending Responsible Organization | ||
| MSH-22.1 | Organization Name | NIST IIS FAC | |
| MSH-22.6 | Assigning Authority | ||
| MSH-22.6.1 | Namespace ID | NIST-AA-1 | |
| MSH-22.6.2 | Universal ID | ||
| MSH-22.6.3 | Universal ID Type | ||
| MSH-22.7 | Identifier Type Code | XX | |
| MSH-22.10 | Organization Identifier | 100-1776 | |
| MSH-23 | Receiving Responsible Organization | ||
| MSH-23.1 | Organization Name | NIST EHR Facility | |
| MSH-23.6 | Assigning Authority | ||
| MSH-23.6.1 | Namespace ID | NIST-AA-1 | |
| MSH-23.6.2 | Universal ID | ||
| MSH-23.6.3 | Universal ID Type | ||
| MSH-23.7 | Identifier Type Code | XX | |
| MSH-23.10 | Organization Identifier | 100-6482 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| MSA-1 | Acknowledgment Code | AA | |
| MSA-2 | Message Control ID | NIST-IZ-4.1_Query_Q11_Z44 |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QAK-1 | Query Tag | IZ-4.1-2015 | |
| QAK-2 | Query Response Status | TM | |
| QAK-3 | Message Query Name | ||
| QAK-3.1 | Identifier | Z44 | |
| QAK-3.2 | Text | request evaluated Immunization history | |
| QAK-3.3 | Name of Coding System | CDCPHINVS | |
| QAK-3.5 | Alternate Text | ||
| QAK-3.6 | Name of Alternate Coding System |
| Location | Data Element | Data | Categorization |
|---|---|---|---|
| QPD-1 | Message Query Name | ||
| QPD-1.1 | Identifier | Z44 | |
| QPD-1.2 | Text | Request Evaluated History and Forecast | |
| QPD-1.3 | Name of Coding System | CDCPHINVS | |
| QPD-1.5 | Alternate Text | ||
| QPD-1.6 | Name of Alternate Coding System | ||
| QPD-2 | Query Tag | IZ-4.1-2015 | |
| QPD-3 | PatientList | ||
| QPD-3.1 | ID Number | 412299 | |
| QPD-3.3 | Check Digit Scheme | ||
| QPD-3.4 | Assigning Authority | ||
| QPD-3.4.1 | Namespace ID | NIST MPI | |
| QPD-3.4.2 | Universal ID | ||
| QPD-3.4.3 | Universal ID Type | ||
| QPD-3.5 | Identifier Type Code | MR | |
| QPD-4 | PatientName | ||
| QPD-4.1 | Family Name | ||
| QPD-4.1.1 | Surname | Smith | |
| QPD-4.1.2 | Own Surname Prefix | ||
| QPD-4.1.3 | Own Surname | ||
| QPD-4.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD-4.1.5 | Surname From Partner/Spouse | ||
| QPD-4.2 | Given Name | James | |
| QPD-4.3 | Second and Further Given Names or Initials Thereof | ||
| QPD-4.7 | Name Type Code | L | |
| QPD-5 | PatientMotherMaidenName | ||
| QPD-5.1 | Family Name | ||
| QPD-5.1.1 | Surname | ||
| QPD-5.1.2 | Own Surname Prefix | ||
| QPD-5.1.3 | Own Surname | ||
| QPD-5.1.4 | Surname Prefix From Partner/Spouse | ||
| QPD-5.1.5 | Surname From Partner/Spouse | ||
| QPD-5.7 | Name Type Code | ||
| QPD-6 | PatientDateOfBirth | ||
| QPD-6.1 | Time | 20110905 | |
| QPD-7 | Patient Sex | M | |
| QPD-8 | Patient Address | ||
| QPD-8.1 | Street Address | ||
| QPD-8.1.1 | Street or Mailing Address | 22 East Branch Way | |
| QPD-8.1.2 | Street Name | ||
| QPD-8.1.3 | Dwelling Number | ||
| QPD-8.2 | Other Designation | ||
| QPD-8.3 | City | Livingston | |
| QPD-8.4 | State or Province | MT | |
| QPD-8.5 | Zip or Postal Code | 59047 | |
| QPD-8.6 | Country | ||
| QPD-8.7 | Address Type | L | |
| QPD-9 | Phone | ||
| QPD-9.2 | Telecommunication Use Code | PRN | |
| QPD-9.3 | Telecommunication Equipment Type | PH | |
| QPD-9.4 | Email Address | ||
| QPD-9.6 | Area/City Code | 406 | |
| QPD-9.7 | Local Number | 5556285 | |
| QPD-10 | Multiple birth indicator | ||
| QPD-11 | Birth order |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Element | Data |
|---|---|
| This information will be automatically supplied by the System | |
| Evaluated Immunization History and Immunization Forecast | |||||
|---|---|---|---|---|---|
| Test Case ID | IZ-QR-4_Query_Too_Many | ||||
| Juror ID | |||||
| Juror Name | |||||
| HIT System Tested | |||||
| Inspection Date/Time | |||||
| Inspection Settlement (Pass/Fail) |
|
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| Reason Failed | |||||
| Juror Comments | |||||
This Test Case-specific Juror Document provides a checklist for the Tester to use during certification testing for assessing the EHR technology's ability to display information notifying the HIT user that a Return Acknowledgement with No Person Records Z33 message was received (in response to an Evaluated Immunization History and Immunization Forecast Z44 query message). Additional data from the message or from the EHR are permitted to be displayed by the EHR.
The format of this Juror Document is for ease-of-use by the Tester and does not indicate how the EHR display must be designed.
The data shown in this Juror Document are derived from the test data provided with the given Test Case; equivalent data are permitted to be displayed by the EHR. The column headings are meant to convey the kind of data to be displayed; equivalent labels/column headings are permitted to be displayed by the EHR.
| Patient Information | ||||
|---|---|---|---|---|
| Patient Identifier | Patient Name | DOB | Gender | Tester Comment |
| 412299 | James Smith | 09/05/2011 | Male | |
| When displayed in the EHR with the notification indicating that a Return Acknowledgement with No Person Records Z33 message was received, these patient demographics data are derived from the EHR patient record. | ||||
| Evaluated Immunization History and Immunization Forecast |
|---|
| The EHR shall display a notification indicating that the query for an Evaluated Immunization History and Immunization Forecast is complete but too many matching records were found for the person in the query. |